Publications by authors named "Nanze Yu"

95 Publications

Ultrasonographic Analysis of the Calves for Efficient Botulinum Toxin Type A Injection.

J Cosmet Dermatol 2022 Jul 27. Epub 2022 Jul 27.

Department of Plastic and Cosmetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Background: Large calves are considered unattractive. Botulinum toxin type A (BoNT-A), acting as a neurotoxin that reduces muscle contraction, is widely used in calf contouring. However, there lacks detailed anatomical data to guide clinical injection.

Objectives: This study aims to use ultrasonography to provide depth information of the calf muscles and determine the morphological types of the gastrocnemius muscle.

Methods: Forty healthy young women were enrolled. A real-time ultrasound scanner with a 30-mm-wide linear-array transducer was used to detect the depth information of the gastrocnemius muscle, and the soleus muscle.

Results: The thickness of the gastrocnemius muscle and the soleus muscle was measured. The depth from the skin to the surface, the middle, and the bottom of the gastrocnemius muscle was measured to guide BoNT-A injection. The morphology of gastrocnemius muscle was classified into four different types under ultrasound according to the muscle bulge pattern.

Conclusion: This study took ultrasonic measurements of Asian calves to guide accurate and effective BoNT-A injection in real clinical practice.
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http://dx.doi.org/10.1111/jocd.15279DOI Listing
July 2022

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Ann Transl Med 2022 Jun;10(11):650

Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

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http://dx.doi.org/10.21037/atm-22-1324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9263771PMC
June 2022

Tarsus-Orbicularis-Septum Fixation in Double-Eyelid Blepharoplasty: A Reliable and Flexible Technique.

Clin Cosmet Investig Dermatol 2022 21;15:1125-1132. Epub 2022 Jun 21.

Division of Plastic Surgery, Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

Purpose: Incisional double eyelid blepharoplasty is the most common cosmetic operation in East Asia. Although numerous articles on surgical techniques have been published, complications, such as fold loss, asymmetry, and visible scars, still exist. To create a stable and dynamic double-eyelid crease, the author has introduced a modified technique of double-eyelid blepharoplasty.

Patients And Methods: The authors introduced a new surgical technique to reduce complications and create reliable and dynamic double eyelids. The orbicularis oculi muscle of the lower flap was anchored on the tarsus and sutured with the distal part of the septal flap. The skin incision was closed by skin-septal flap-skin suture. Postoperative evaluations were assessed at the twelfth postoperative month.

Results: One hundred ninety-three patients underwent double eyelidplasty with the TOS fixation technique. The mean follow-up duration was 18.6 months (range, 12-30 months). In the aesthetic outcome evaluation, 88 (45.6%) patients had very much improved results, 56 (29.0%) had much improved results, 29 (15.0%) had improved results, 8 (4.1%) had no change and 12 (6.2%) had worse results. Complications included crease asymmetry (n=7, 3.6%), partial fold loss (n=8, 4.1%) and complete fold loss (n =5, 2.6%).

Conclusion: Tarsus-orbicularis-septum (TOS) fixation is a reliable and flexible surgical technique for creating stable and dynamic double-eyelid creases.
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http://dx.doi.org/10.2147/CCID.S367202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233541PMC
June 2022

"Nurturing future leaders in aesthetics: Now is the time".

Facial Plast Surg 2022 Jun 25. Epub 2022 Jun 25.

Plastic Surgery, Plastic Surgery, Thessaloniki, Greece.

There is a need for a specialist pathway or progression in aesthetic medicine for aesthetic physicians. A structured program for specialised training in non-surgical facial aesthetics to empower physicians is the need of the hour. The pharmaceutical companies currently provide training sessions, taking considerable initiatives to train aesthetic professionals. "Leaders of the future" is a global thought leadership program by Allergan Aesthetics. The program was designed to support and nurture the next generation of leaders by focusing on science and evidence. It aimed to help practitioners grow, evolve, learn, share, and connect with leading international experts. The sessions were focused on the importance of science and sensibility in aesthetic medicine, as well as critical thinking and leadership skills. Mentorship is one of the most effective approaches for transforming the lives of young aesthetic practitioners and, in turn, future patients. In addition, the importance of in-depth knowledge of injection anatomy for safe practice was emphasised. As aesthetic surgeons and physicians, we must commit to incorporating evidence-based medicine into our lifelong practice. "Leaders of the future" programme aims to build a solid foundation for aesthetic surgeons and physicians to grow and evolve as thought leaders. The programme would also aid in the pursuit of a best aesthetic practice that incorporates professional identity formation, clinical competence, and evidence-based management in non-surgical aesthetics.
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http://dx.doi.org/10.1055/a-1885-1018DOI Listing
June 2022

A Workflow for Computer-Aided Evaluation of Keloid Based on Laser Speckle Contrast Imaging and Deep Learning.

J Pers Med 2022 Jun 16;12(6). Epub 2022 Jun 16.

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

A keloid results from abnormal wound healing, which has different blood perfusion and growth states among patients. Active monitoring and treatment of actively growing keloids at the initial stage can effectively inhibit keloid enlargement and has important medical and aesthetic implications. LSCI (laser speckle contrast imaging) has been developed to obtain the blood perfusion of the keloid and shows a high relationship with the severity and prognosis. However, the LSCI-based method requires manual annotation and evaluation of the keloid, which is time consuming. Although many studies have designed deep-learning networks for the detection and classification of skin lesions, there are still challenges to the assessment of keloid growth status, especially based on small samples. This retrospective study included 150 untreated keloid patients, intensity images, and blood perfusion images obtained from LSCI. A newly proposed workflow based on cascaded vision transformer architecture was proposed, reaching a dice coefficient value of 0.895 for keloid segmentation by 2% improvement, an error of 8.6 ± 5.4 perfusion units, and a relative error of 7.8% ± 6.6% for blood calculation, and an accuracy of 0.927 for growth state prediction by 1.4% improvement than baseline.
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http://dx.doi.org/10.3390/jpm12060981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224605PMC
June 2022

Single-cell RNA sequencing of subcutaneous adipose tissues identifies therapeutic targets for cancer-associated lymphedema.

Cell Discov 2022 Jun 21;8(1):58. Epub 2022 Jun 21.

Division of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.

Cancer-associated lymphedema frequently occurs following lymph node resection for cancer treatment. However, we still lack effective targeted medical therapies for the treatment or prevention of this complication. An in-depth elucidation of the cellular alterations in subcutaneous adipose tissues of lymphedema is essential for medical development. We performed single-cell RNA sequencing of 70,209 cells of the stromal vascular fraction of adipose tissues from lymphedema patients and healthy donors. Four subpopulations of adipose-derived stromal cells (ASCs) were identified. Among them, the PRG4/CLEC3B ASC subpopulation c3 was significantly expanded in lymphedema and related to adipose tissue fibrosis. Knockdown of CLEC3B in vitro could significantly attenuate the fibrogenesis of ASCs from patients. Adipose tissues of lymphedema displayed a striking depletion of LYVE anti-inflammatory macrophages and exhibited a pro-inflammatory microenvironment. Pharmacological blockage of Trem1, an immune receptor predominantly expressed by the pro-inflammatory macrophages, using murine LR12, a dodecapeptide, could significantly alleviate lymphedema in a mouse tail model. Cell-cell communication analysis uncovered a perivascular ligand-receptor interaction module among ASCs, macrophages, and vascular endothelial cells. We provided a comprehensive analysis of the lineage-specific changes in the adipose tissues from lymphedema patients at a single-cell resolution. CLEC3B was found to be a potential target for alleviating adipose tissue fibrosis. Pharmacological blockage of TREM1 using LR12 could serve as a promising medical therapy for treating lymphedema.
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http://dx.doi.org/10.1038/s41421-022-00402-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209506PMC
June 2022

Ultrasonographic observation of the masseter muscle after injection of different botulinum toxin type A.

J Cosmet Dermatol 2022 May 23. Epub 2022 May 23.

Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Department of Plastic Surgery, Beijing, China.

Background: Botulinum toxin type A (BoNT-A) injection is a popular cosmetic procedure in East Asian countries, and there are multiple types of toxins on the market. Whether different toxin types induce different changes in the masseter has not been studied.

Objective: We aimed to investigate and compare the changes induced by injection of different types of BoNT-A in the masseter.

Methods: Upon retrospective review of clinical records and routine ultrasound examination results of patients who underwent BoNT-A injection, four groups were set for comparison: unapproved toxin, OnabotulinumtoxinA, LanbotulinumtoxinA, and non-injected. Clinical records and ultrasound images were collected. Ultrasound images were taken in both horizontal and coronal planes. Elasticity of the masseter muscle was also investigated by measuring the surface wave speed.

Results: A total of 24 patients were included (six patients per group). All patients were young females. For the non-injected group, the deep inferior tendon was clear and the muscle bundles were arranged, with little fibrous content. Patients who received unapproved toxin injection showed highly disarranged muscle and fiber bundles, with much fiber content present. The changes in OnabotulinumtoxinA and LanbotulinumtoxinA groups were in between those in the non-injected and unapproved toxin groups. Muscle rigidity was the highest in the unapproved toxin group, and generally higher in injected groups compared with the non-injected group.

Conclusion: Different types of BoNT-A may induce different changes in the masseter.
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http://dx.doi.org/10.1111/jocd.15106DOI Listing
May 2022

Giant pilomatrixoma with bullous appearance on the back: A case report and discussion of misdiagnosis.

J Cosmet Dermatol 2022 Mar 25. Epub 2022 Mar 25.

Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China.

Pilomatrixoma is a benign, asymptomatic skin tumor that forms from hair follicle matrix cells. Most are under 3 cm in diameter and occur on the head, face, or neck. Bullous appearance is very rare in pilomatrixoma. In this case report, we present a case of bullous pilomatrixoma of unusual size, region, symptoms, and patient age. It had been misdiagnosed as a keloid and as dermatofibrosarcoma protuberans. Early treatments were ineffective. The patient approached our outpatient facility and underwent excision. He was then diagnosed with pilomatrixoma by pathological examination. The clinical appearance of this case was quite difficult to diagnose, even MRI and B-ultrasonic examinations provided limited diagnostic evidence. Given the revelations from this case, we reemphasize the importance of performing a biopsy (if patients refused operation or preferred conservative treatment) before any invasive treatment to minimize economic or time loss of patients who have difficulties in diagnosis.
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http://dx.doi.org/10.1111/jocd.14934DOI Listing
March 2022

The reconstructive strategy for pelvic oncological surgery with various types of MS-VRAM flaps.

J Plast Reconstr Aesthet Surg 2022 07 24;75(7):2090-2097. Epub 2022 Feb 24.

Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.41 Damucang Hutong, Xicheng District, Beijing, China.

Background: Muscle-sparing vertical rectus abdominis myocutaneous (MS-VRAM) flaps are widely used in pelvic reconstruction. Aiming at optimal reconstructive outcomes, flap design and modification should be individualized to restore various kinds of defects.

Objective: Summarize an empirical strategy about MS-VRAM selection for different pelvic and perineal reconstructions.

Methods: Thirty patients who underwent total pelvic exenteration and pelvic reconstruction surgery from 2009 to 2017 were enrolled. The patients were divided into four groups according to the type of MS-VRAM-based flap used in the procedure: the modified long vertical flap (n = 10), the wrapping flap (n = 6), the de-epithelialized flap (n = 6), and the cork flap (n = 8). The follow-up period was 1 year after the surgery. Flap size, drainage volume, postoperative satisfaction, and complications were recorded, and postoperative photographs were collected.

Results: All of the patients achieved satisfying effect under the targeted reconstruction strategy. Of the four groups, the accurate cork flap finally acquires higher satisfaction, the shortest hospital stay, and the least total drainage volume. Meanwhile, the incidence of complications was not increased compared with the other groups.

Conclusions: A new reconstructive strategy for pelvic reconstruction was established. Functional or non-functional reconstruction was accomplished by using various MS-VRAM flaps. Among them, the cork flap is the most economical flap to reconstruct pelvic floor defects with minimal tissue requirement and donor trauma.
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http://dx.doi.org/10.1016/j.bjps.2022.02.014DOI Listing
July 2022

Fused Lateral Clitoral Hood and Labia Minora: New Classification Based on Anatomic Variation of the Clitoral Hood-Labia Minora Complex and Simple Surgical Management.

Aesthet Surg J 2022 Aug;42(8):907-917

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China.

Background: Existing classifications of the clitoral hood-labia minora complex (CLC) have neglected its integrity and anatomic variation, resulting in failure to optimize approaches tailored to individuals.

Objectives: The aim of this study was to present a new classification system for comprehensive evaluation of variations of the CLC and to introduce a simple surgical approach for the fused type.

Methods: Anatomic variations of the CLC were classified into 3 types: isolated labia minora or lateral clitoral hood hypertrophy (Type 1); conventional combined hypertrophy (Type 2); and fused lateral clitoral hood and labia minora (Type 3). A modified procedure for the fused type was performed in 4 steps: the anterior border of labia minora was defined first, then the hypertrophic lateral clitoral hood and labia minora were each removed separately, and finally the junction region was trimmed. Satisfaction questionnaires were administered during follow-ups.

Results: Among all 301 patients (602 sides), Type 2 was the most common variation (285 sides, 47.3%). Type 3 variations in 67 patients (105 sides, 17.5%) were identified, and 77.6% of these patients answered the questionnaires 3 months after surgery. For patients with type 3 variations, the satisfaction rate in the 4-step excision group was 91.7%, which was significantly higher than that in the wedge excision group (56.3%) (P = 0.01). The complication rate of the 4-step excision was 2.5%.

Conclusions: Preoperative evaluation based on the new classification facilitated recognition of variations of the CLC, especially of the fused type. The 4-step excision is a simple, effective, and safe approach to treat the fused variation with high satisfaction.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjac039DOI Listing
August 2022

Pivotal role of injection volume on sunken cheek prevention in masseter muscle BoNT-A injection: A cadaver study.

J Cosmet Dermatol 2022 Jan 12;21(1):137-141. Epub 2021 Dec 12.

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Botulinum neurotoxin A injection is a popular noninvasive alternative for the treatment of masseter hypertrophy. This study was conducted to identify a safe injection volume to avoid sunken lateral cheek after botulinum neurotoxin A injection in the masseter muscle.

Methods: One milliliter or 0.5 ml of indocyanine green was randomly injected into either side of the masseter muscles of 18 fresh cadaver heads. The bilateral spreads of indocyanine green within the masseter were observed by a fluorescence imager. The masseters were then dissected, and the spreading distance was measured.

Results: Dye spreading showed an oval shape parallel to the long axis of the masseter muscle. The lower edges of the masseters were all stained with indocyanine green. The upward spreading exceeded the mouth corner-tragus line in 94.44% (17/18) of the masseters on the 1-ml side, and 11.11% (2/18) of the masseters on the 0.5-ml side. The spreading area and upward spreading distance on the 1-ml side (9.95 ± 0.48 cm , 3.18 ± 0.31 cm) were significantly larger than the 0.5-ml side (7.13 ± 0.80 cm , 2.08 ± 0.32 cm).

Conclusions: The spread of indocyanine green within the masseter occurs in direct proportion to its volume. A bolus of 1 ml easily exceeded the mouth corner-tragus line and cause sunken cheek.
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http://dx.doi.org/10.1111/jocd.14658DOI Listing
January 2022

Three-Step Excision: An Easy Way for Composite Labia Minora and Lateral Clitoral Hood Reduction.

Plast Reconstr Surg 2021 Dec;148(6):928e-935e

From the Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences.

Background: Hypertrophy of the labia minora with lateral clitoral hood redundancy is common, but the excess clitoral hood is often overlooked during labiaplasty, which may result in imbalanced and unsatisfactory outcomes. The purpose of this study was to present an easy method of three-step excision for composite labia minora and lateral clitoral hood reduction.

Methods: The procedure was performed in three steps: the prominent clitoral hood skin parallel to the labia majora and the clitoral hood sulcus was removed first; then, the protuberant portion of the labia minora was removed by wedge resection; and finally, a triangle at the junction between the labia minora and the clitoral hood was trimmed. Patients were required to return for examination on the first day and within 14 days after surgery. Follow-ups were arranged on the Internet or at the outpatient clinic. Satisfaction questionnaires were completed during follow-up.

Results: Between January of 2016 and January of 2020, 136 patients underwent composite labia minora and lateral clitoral hood reduction. Ages ranged from 9 to 55 years. Six patients experienced complications (4.4 percent) and five underwent revision surgery (3.7 percent). The overall satisfaction rate within 14 days and after 3 months following surgery was 91.0 percent and 95.5 percent, respectively. Preoperative discomfort was resolved in 43.0 percent and significantly relieved in 54.2 percent, and sex life was improved in 70.9 percent.

Conclusions: Three-step excision is effective and safe for composite labia minora and lateral clitoral hood reduction with very high satisfaction. Considering the advantages of easy preoperative design and controllable tissue removal, this method could be a better alternative to the present procedures.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000008589DOI Listing
December 2021

Activity of keloids evaluated by multimodal photoacoustic/ultrasonic imaging system.

Photoacoustics 2021 Dec 11;24:100302. Epub 2021 Sep 11.

Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Multiple objective assessments have been used to assess the activity of keloids to compare different therapeutic regimens and facilitate the best individual treatment choice for patients, but none of them are standardized. A multimodal photoacoustic/ultrasonic (PA/US) imaging system, including photoacoustic imaging, elastography, ultra-micro-angiography, and conventional US technologies (gray scale US, color Doppler US, and power Doppler US), was applied to evaluate keloids by a radiologist. Growing stages were defined by patients, and Vancouver Scar Scale (VSS) was assessed by a plastic surgeon. A comprehensive model based on multimodal ultrasound parameters (poor-echo pattern, high vascular density, decreased elasticity, and low SO within the keloid) and VSS might be a potential indicator of active keloids, comparing with VSS alone. The multimodal PA/US imaging system could be a promising technique for keloids assessment.
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http://dx.doi.org/10.1016/j.pacs.2021.100302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441086PMC
December 2021

Three-dimensional facial scanner in the hands of patients: validation of a novel application on iPad/iPhone for three-dimensional imaging.

Ann Transl Med 2021 Jul;9(14):1115

Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

Background: Three-dimensional (3D) photography plays an important role in surgical planning and postoperative evaluation. Commercial 3D facial scanners are expensive, and they require patients to come to the clinics for 3D photography. To solve this problem, we developed an iPad/iPhone application to enable patients to capture 3D images of themselves on their own. This study aimed to evaluate the validity and reproducibility of this novel imaging system.

Methods: 3D images were taken on 20 volunteers using the novel imaging system. Twenty-one anthropometric parameters were measured using calipers (direct measurement) and 3D photographs (3D photogrammetry). The results were compared to assess the accuracy and bias of 3D photogrammetry. The reproducibility was evaluated by testing intra- and interobserver reliabilities. Furthermore, 3D virtual models obtained by the novel imaging system and Vectra H1 camera were compared by performing heat map analysis.

Results: The 3D photogrammetric results showed excellent correlations with direct measurements. Most anthropometric parameters did not show statistically significant differences between the two methods. The 95% limits of agreement exceeded 2 mm in some parameters, especially those with large numbers, although their relative error measurements were very small. Intra- and interobserver reliabilities were high enough to ensure good reproducibility. The comparison of 3D models obtained by the novel imaging system and Vectra H1 camera showed that the mean distance and the mean RMS were 0.08 and 0.67 mm, respectively.

Conclusions: The novel 3D facial scanning system is validated to enable patients to take 3D images on their own. The imaging quality of the subnasale region needs further improvement. Future clinical applications include surgical planning, postoperative evaluation, and early diagnosis of diseases that affect facial appearance.
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http://dx.doi.org/10.21037/atm-21-1620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350646PMC
July 2021

Repigmentation of nipple-areola complex after ReCell® treatment on breast vitiligo.

J Cosmet Dermatol 2022 Jun 20;21(6):2530-2534. Epub 2021 Aug 20.

Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.

Background: Nipple-areola complex is a naturally hyperpigmented skin area which can be involved in vitiligo. But limited study focused on the treatment of nipple-areola complex vitiligo, and few methods were proven to be effective. In this study, we aimed to explore the feasibility and efficacy of ReCell® on vitiligo in the nipple-areola complex area.

Methods: Medical records of patients with vitiligo involving nipple-areola complex and underwent ReCell® treatment from October 2016 to April 2020 were retrospectively reviewed. The repigmentation rate of the nipple-areola complex and other breast area were calculated under the Wood's light at each follow-up. The grade of repigmentation and patient-reported satisfaction rate were also evaluated to prove the effect of ReCell® on vitiligo of breast and especially in the nipple-areola complex area.

Results: A total of 18 patients were included in this study. No surgical complications were reported. The mean postoperative repigmentation rate in the nipple-areola complex area (3rd-month, 78.7 ± 5.8%; 6th-month, 87.6 ± 5.1%; and 12th-month, 96.1 ± 3.5%) was significantly higher than that in the other breast treatment area (3rd-month, 70.4 ± 6.9%; 6th-month, 84.2 ± 5.7%, and 12th-month, 93.2 ± 3.6%). All patients showed good or excellent grades at the last follow-up, and 94.4% of them considered the overall treatment results satisfactory.

Conclusions: ReCell® is a feasible and efficient treatment strategy in the nipple-areola complex vitiligo.
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http://dx.doi.org/10.1111/jocd.14399DOI Listing
June 2022

Treatment of Keloids Using Plasma Skin Regeneration Combined with Radiation Therapy Under the Evaluation of Patient and Observer Scar Assessment Scale.

Clin Cosmet Investig Dermatol 2021 5;14:981-989. Epub 2021 Aug 5.

Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.

Purpose: Keloids are caused by uncontrolled excessive proliferation of fibrous tissue. Multiple treatment strategies including steroid injection, surgical excision, laser therapy and radiation therapy have been reported. Few studies have evaluated the performance of plasma skin regeneration (PSR) in the treatment of keloid. This study aimed to evaluate the effectiveness of PSR combined with radiation therapy for keloids on different body parts.

Patients And Methods: A total of 71 patients with 98 keloids were enrolled in this study. Keloids <4 mm thick underwent single-dose PSR, while keloids ≥4 mm thick were administered compound betamethasone injection beforehand. Radiation therapy was administered after 24 hours and again 7 days later after PSR. The outcome was evaluated using the patient and observer scar assessment scale at 12 months post-treatment.

Results: Patient-reported average scores for all keloids significantly decreased from 35.05±9.94 to 21.84±7.04 (p < 0.05). Keloids on face and neck, chest, and back responded better than those on shoulders and limbs. The recurrence rate was observed to be 15.3% (15 out of 98). Adverse effects were mild.

Conclusion: PSR combined with radiation therapy is an effective and safe strategy to treat keloids. Location could be a factor that affects curative effects.
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http://dx.doi.org/10.2147/CCID.S321348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353170PMC
August 2021

The "Visible" Muscles on Ultrasound Imaging Make Botulinum Toxin Injection More Precise: A Systematic Review.

Aesthetic Plast Surg 2022 Feb 2;46(1):406-418. Epub 2021 Aug 2.

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing, 100730, China.

Background: Botulinum toxin (BoNT) injection is the most commonly performed procedure in cosmetic surgery. However, blind injection is unable to take individual anatomical variations into consideration, which is the main contributing factor to complications. Ultrasound (US) imaging was introduced to reduce complications and improve effects. This article will review uses of US in aesthetic BoNT injection.

Method: A systematic electronic search was performed using the PubMed, MEDLINE, Web of science. Search terms were set to focus on aesthetic BoNT injection. Two independent reviewers subsequently reviewed the resultant articles based on strict inclusion and exclusion criteria. Selected manuscripts were analysed and grouped by procedure categories. Clinical cases were all performed by one plastic surgeon in our department.

Results: The search finally retained 24 articles. Five procedural categories were identified, including masseter (n = 16), frontalis (n = 2), glabella complex (n = 2), trapezius (n=1), and gastrocnemius (n = 3). US imaging is practical and instructive for pre-operative assessments as in needle-type selection, injection point localization and depth setting, as well as post-operative follow-ups regarding injection feedback (for instance, the extent of muscle volume decreases). What's more, ultrasound-guided injection makes needle trajectory visualized so as for the needle to reach the target muscle in avoidance of potential damage to neurovascular bundle, gland or adjacent muscle.

Conclusion: Muscles, such as masseter, frontalis, glabella complex, trapezius and gastrocnemius, and their adjacent structures can be well visualized using US, and as such, US can be a useful tool for a variety of pre-operative, intra-operative and post-operative procedures.

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 .
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http://dx.doi.org/10.1007/s00266-021-02493-zDOI Listing
February 2022

Single-Cell RNA-Sequencing Reveals Lineage-Specific Regulatory Changes of Fibroblasts and Vascular Endothelial Cells in Keloids.

J Invest Dermatol 2022 01 7;142(1):124-135.e11. Epub 2021 Jul 7.

Division of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China. Electronic address:

Keloids are a benign dermal fibrotic disorder with features similar to malignant tumors. keloids remain a therapeutic challenge and lack medical therapies, which is partially due to the incomplete understanding of the pathogenesis mechanism. We performed single-cell RNA-sequencing of 28,064 cells from keloid skin tissue and adjacent relatively normal tissue. Unbiased clustering revealed substantial cellular heterogeneity of keloid tissue, which included 21 clusters assigned to 11 cell lineages. We observed significant expansion of fibroblast and vascular endothelial cell subpopulations in keloids, reflecting their strong association with keloid pathogenesis. Comparative analyses were performed to identify the dysregulated pathways, regulators and ligand-receptor interactions in keloid fibroblasts and vascular endothelial cells. Our results highlight the roles of TGFβ and Eph-ephrin signaling pathways in both the aberrant fibrogenesis and angiogenesis of keloids. Critical regulators probably involved in the fibrogenesis of keloid fibroblasts, such as TWIST1, FOXO3 and SMAD3, were identified. TWIST1 inhibitor harmine could significantly suppress the fibrogenesis of keloid fibroblasts. In addition, tumor-related pathways were activated in keloid fibroblasts and vascular endothelial cells, which may be responsible for the malignant features of keloids. Our study put insights into the pathogenesis of keloids and provides potential targets for medical therapies.
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http://dx.doi.org/10.1016/j.jid.2021.06.010DOI Listing
January 2022

Blood supply of the male breast nipple-areola complex evaluated by CTA.

J Plast Reconstr Aesthet Surg 2021 Oct 10;74(10):2588-2595. Epub 2021 Mar 10.

Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuai Fu Yuan 1#, Dongcheng Dist., Beijing 100730, China. Electronic address:

Purpose: In addition to women, men also undergo breast surgeries, and early studies on the blood supply of breasts are nearly all conducted in female subjects. The vasculature of the male breast is seldom studied. Understanding the male-specific blood supply of the breast is important for pre-operative planning and reducing complications. The purpose of this retrospective study is to fill the gap in the literature by describing the main blood supply and its orientation in the male breast.

Methods: We retrospectively evaluated thoracic computed tomographic angiography (CTA) data from January 1, 2017 to July 30, 2019. Single or multiple dominant arteries and their origins were traced, and the artery route and orientation related to the nipple-areola complex (NAC) were revealed through data analysis of the images.

Results: Totally, 284 breasts were included. Most breasts were supplied by a single dominant artery (196, 69%), among which the lateral thoracic artery (LTA; 119, 41.9%; type I) and internal thoracic artery (ITA; 63, 22.2%; type II) were the most common arteries. A minority of breasts were supplied by vascular anastomoses formed by dual arteries (17, 6.0%; type III), and in 25.0% of breasts, no specific dominant artery was found (type IV). The predominant artery distribution was evaluated.

Conclusion: This study cohort of male thoracic CTA provided and analysed the elaborate vascular anatomy of the NAC region. Our results favour inferior periareolar incision in regard to diminished vascular-related complications in male surgeries without pre-operative vascular evaluation. This study also suggests that super-lateral or lower-lateral-based pedicles can reserve more vasculature.
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http://dx.doi.org/10.1016/j.bjps.2021.02.006DOI Listing
October 2021

Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review.

Aesthet Surg J 2022 Feb;42(3):NP162-NP175

Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Background: With the growth in the popularity of facial filler injections, increased numbers of severe adverse events, such as cerebral embolism, have been reported.

Objectives: The aim of this article was to summarize the clinical manifestations and proposed mechanisms of filler-induced cerebral embolism (FICE).

Methods: A literature review was performed with the search keywords "filler injection," "hyaluronic acid," "fat graft," "cerebral infarction," "cerebral embolism," "stroke," "cerebrovascular infarction," "disorders of consciousness," and "hemiplegia."

Results: Among the 43 cases of FICE enrolled from 35 articles, 37 patients were female, and 6 were male. Twenty-nine of these patients had received fat grafting, and 12 hyaluronic acid injection. Most FICE patients had been injected in the glabella, followed by the temporal, forehead, and nasal areas. Among 30 patients injected under local anesthesia, 43.33% presented with neurologic symptoms during the procedure. The main symptoms were consciousness disorders and hemiplegia. Most of the embolization sites were in the middle cerebral artery, followed by frontal lobe infarction and anterior cerebral artery infarction. Three patients developed cerebral hemorrhage after embolism. Twenty-six patients presented with newly acquired vision loss. The management for FICE cases included embolectomy, thrombolysis, decompressive craniectomy, antiplatelet/anticoagulant therapy, and symptomatic and nutritional treatment. Nearly half of the patients recovered or exhibited improved neurologic manifestations but not visual loss. Five patients died.

Conclusions: FICE is a severe complication following facial filler injection. Careful prevention, timely identification, and treatment are crucial to decreasing the morbidity and mortality of FICE.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjab193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8844978PMC
February 2022

False Sense of Safety: Blunt Cannulas Cause the Majority of Severe Vascular Complications in Hyaluronic Acid Injection.

Plast Reconstr Surg 2021 04;147(4):694e-695e

Division of Plastic Surgery, Peking Union Medical College Hospital, Beijing, People's Republic of China.

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http://dx.doi.org/10.1097/PRS.0000000000007714DOI Listing
April 2021

The Development and Initial Validation of PUMC Localized Scleroderma Facial Aesthetic Index: A Pilot Study.

Aesthetic Plast Surg 2021 08 15;45(4):1531-1539. Epub 2021 Jan 15.

Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Background: Localized scleroderma (LoS) is an autoimmune connective tissue disorder leading to serious long-term aesthetic impairment on patients. Objective evaluation methods are badly needed to facilitate the evaluation of the surgical treatment on individual patients and clinical studies.

Objective: To develop and assess the reliability and validity of Peking Union Medical College LoS facial aesthetic index (PUMC LoSFAI).

Methods: Twelve experts devoted their time and resources in the development and validation. LoS patients in the stable phase were recruited. Reliability and validity was then assessed. LoS patients were evaluated by two plastic surgeons using PUMC LoSFAI and LoS skin damage index (LoSDI). The PUMC LoSFAI comprises 4 domains for the local assessment (surface area of lesion, dyspigmentation, skin thickness and soft tissue atrophy) and 3 domains for the overall assessment (facial symmetry, proportion and profile) to describe LoS facial aesthetic impairment. Face-Q was completed by patients at each visit.

Results: Thirty-two LoS patients had 96 visits, during which 138 lesions were assessed. PUMC LoSFAI and 7 domains demonstrated substantial to excellent inter- and intra-rater reliability (ICC 0.995, κ 0.72-0.91, r 0.85-0.99, respectively). Seven domains considered to be important to extremely important variables (mean rank 3.2-3.8) had high I-CVI (> 0.78) and S-CVI (0.93). PUMC LoSFAI correlated excellently with LoSDI (r = 0.933, P < 0.001), and correlated fairly with Face-Q (r = - 0.399, P = 0.001).

Conclusions: PUMC LoSFAI was developed and evaluated to play as a tool of aesthetic impairment assessment for LoS patients, which may facilitate the evaluation of the treatment on individual patients and clinical studies. PUMC LoSFAI demonstrated high reliability and validity, and further study in larger patient samples is needed to confirm these preliminary findings.

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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-020-02111-4DOI Listing
August 2021

SARS-CoV-2 not found in pressure injury exudates from COVID-19 patients.

J Cosmet Dermatol 2021 Feb 21;20(2):372-380. Epub 2020 Dec 21.

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: The emergence of COVID-19 has become a global health emergency. The transmissibility of the disease is of great interest to healthcare workers and scientists alike. The primary route of transmission is via respiratory droplets, but viral RNA has also been found in feces and body fluids such as urine, serum, and semen. So far, there has been no report on whether SARS-CoV-2 is present in the exudates of cutaneous lesions. This study was designed to investigate whether SARS-CoV-2 can be found in the pressure injury exudates in patients with severe COVID-19 infections.

Methods: 46 critically ill COVID-19 patients who were admitted to the ICU of the Sino-French New City Branch of Tongji Hospital in Wuhan between February 4 and April 12 developed pressure injuries. 22 patients with pressure injuries had wound exudates. Wound and pharyngeal swabs of the 22 patients were collected and RT-PCRs were conducted to detect SARS-CoV-2 viral RNA.

Results: At the time of pressure injury, 5 patients still tested positive by pharyngeal swabs, the rest of the 17 patients tested negative. However, none of the wound exudate swabs from the participants tested positive for SARS-CoV-2 by RT-PCR.

Conclusion: Our study suggests that it is rather unlikely that COVID-19 can be transmitted via pressure injury exudates, but we still recommend standardized personal protective equipment, face shield and an additional pair of gloves when treating pressure injuries.
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http://dx.doi.org/10.1111/jocd.13887DOI Listing
February 2021

A Single-Cell Transcriptomic Atlas of Human Skin Aging.

Dev Cell 2021 02 24;56(3):383-397.e8. Epub 2020 Nov 24.

State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China; Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing 100053, China; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100049, China. Electronic address:

Skin undergoes constant self-renewal, and its functional decline is a visible consequence of aging. Understanding human skin aging requires in-depth knowledge of the molecular and functional properties of various skin cell types. We performed single-cell RNA sequencing of human eyelid skin from healthy individuals across different ages and identified eleven canonical cell types, as well as six subpopulations of basal cells. Further analysis revealed progressive accumulation of photoaging-related changes and increased chronic inflammation with age. Transcriptional factors involved in the developmental process underwent early-onset decline during aging. Furthermore, inhibition of key transcription factors HES1 in fibroblasts and KLF6 in keratinocytes not only compromised cell proliferation, but also increased inflammation and cellular senescence during aging. Lastly, we found that genetic activation of HES1 or pharmacological treatment with quercetin alleviated cellular senescence of dermal fibroblasts. These findings provide a single-cell molecular framework of human skin aging, providing a rich resource for developing therapeutic strategies against aging-related skin disorders.
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http://dx.doi.org/10.1016/j.devcel.2020.11.002DOI Listing
February 2021

The Application of Decellularized Adipose Tissue Promotes Wound Healing.

Tissue Eng Regen Med 2020 12 9;17(6):863-874. Epub 2020 Nov 9.

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, China.

Background: Due to adipose-derived stem cells (ASCs) being easy to obtain, their rapid proliferation rate, and their multidirectional differentiation capabilities, they have been widely used in the field of regenerative medicine. With the progress of decellularized adipose tissue (DAT) and adipose tissue engineering research, the role of DAT in promoting angiogenesis has gradually been emphasized.

Methods: We examined the biological characteristics and biosafety of DAT and evaluated the stem cell maintenance ability and promotion of growth factor secretion through conducting in vitro and in vivo studies.

Results: The tested ASCs showed high rat:es of proliferation and adhered well to DAT. The expression levels of essential genes for cell stem maintenance, including OCT4, SOX2, and Nanog were low at 2-24 h and much higher at 48 and 96 h. The Adipogenic expression level of markers for ASCs proliferation including PPARγ, C/EPBα, and LPL increased from 2 to 96 h. Co-culture of ASCs and DAT increased the secretion of local growth factors, such as VEGF, PDGF-bb, bFGF, HGF, EGF, and FDGF-bb, and secretion gradually increased from 0 to 48 h. A model of full-thickness skin defects on the back of nude mice was established, and the co-culture of ASCs and DAT showed the best in vivo treatment effect.

Conclusion: The application of DAT promotes wound healing, and DAT combined with ASCs may be a promising material in adipose tissue engineering and regenerative medicine.
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http://dx.doi.org/10.1007/s13770-020-00286-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710820PMC
December 2020

New Pigmentation After Medical Treatment Suggests Increased Efficacy of Dermabrasion and Noncultured Epidermal Cell Suspension Techniques in Stable Vitiligo.

Dermatol Surg 2021 04;47(4):e142-e145

Department of Dermatovenerology, Guangzhou New Century Vitiligo Prevention and Control Research Institute, Guangzhou, China.

Background: Stable vitiligo has been treated by dermabrasion and noncultured epidermal cell suspension (NCES) effectively. However, not all patches respond well.

Objective: To investigate the efficacy of new pigmentation after medical treatment in the therapy of stable vitiligo.

Materials And Methods: Medical records were retrospectively reviewed from October 2016 to March 2019, and 134 patients with stable vitiligo after medical therapy were further treated with NCES. They were divided into 2 groups: 70 patients in Group 1 had new pigmentation, whereas 64 patients in Group 2 did not. Repigmentation and satisfaction of patients and third-party assessors were evaluated at 3 and 6 months postoperatively.

Results: Repigmentation was scored as excellent (≥76%), good (51%-75%), fair (26%-50%), or poor (≤25%). Repigmentation of the 2 groups at 6 months postoperatively was excellent in 82.9% versus 23.4%, good in 10.0% versus 15.6%, fair in 7.1% versus 13.0%, and poor in 0% versus 48.4%, respectively. A positive correlation between satisfaction and repigmentation was found.

Conclusion: New pigmentation after medical treatment suggests increased efficacy of NCES in treating stable vitiligo.
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http://dx.doi.org/10.1097/DSS.0000000000002820DOI Listing
April 2021

Heterogeneous Features of Keloids Assessed by Laser Speckle Contrast Imaging: A Cross-Sectional Study.

Lasers Surg Med 2021 08 7;53(6):865-871. Epub 2020 Oct 7.

Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.

Background And Objectives: Keloids are described as benign dermal fibroproliferative lesions, and vascularization may play a significant role in their pathogenesis. In this study, laser speckle contrast imaging (LSCI) was used to assess perfusion within keloids and surrounding skin, and perfusion of keloids at different stages was compared.

Study Design/materials And Methods: A total of 59 patients with 110 untreated keloids on the anterior chest were enrolled in this study. Different keloid stages (progressive, stable, and regressive) were defined according to patients' descriptions of whether keloids became larger, stable, or smaller during the previous year. Vancouver Scar Scale (VSS) was assessed by a plastic surgeon, and patient reports on pain and itching were documented. LSCI was used to evaluate blood perfusion of keloids (K), skin adjacent to keloids (A), and nonadjacent skin (N). The mean perfusion of these regions was determined, and ratios (K/N, A/N) were calculated.

Results: A heterogeneous perfusion map was observed among the keloid groups, as well as within each keloid. A positive correlation was found between keloid perfusion and VSS. There were 62 (56.4%) keloids in the progressive stage, 33 (30.0%) keloids in the stable stage, and 15 (13.6%) keloids in the regressive stage. The mean K/N ratios in the progressive, stable, and regressive stages were 2.3 ± 0.5, 1.8 ± 0.3, and 1.5 ± 0.5, respectively. The mean A/N ratios were 1.2 ± 0.4, 1.2 ± 0.2, and 1.0 ± 0.5, respectively. Within each keloid, significantly higher perfusion was noted in the keloid and adjacent skin compared with nonadjacent skin.

Conclusion: These results indicate that LSCI is a promising technique for evaluating keloid blood perfusion and distinguishing heterogeneous keloids. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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http://dx.doi.org/10.1002/lsm.23331DOI Listing
August 2021

The use of botulinum toxin A in upper lip augmentation.

J Cosmet Dermatol 2021 Jan 26;20(1):71-74. Epub 2020 Oct 26.

Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China.

Background: Full lips are beauty standards. Botulinum toxin A (BTA) paralyzes the orbicularis oris muscle to achieve the eversion of the lip, and thus makes the lip look plump.

Aims: This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and the lip surface area.

Methods: Three patients received a total of 4U BTA injection at the vermilion border of the upper lip. Vectra® H1 3D imaging system was used to capture 3D photographs of the lips before injection and two weeks after injection. Eight linear distances and the upper lip surface area were measured. Anthropometric measurements before and after injection were compared.

Results: Patients displayed a larger upper vermillion height (P = .038) and a smaller cutaneous upper lip height (P = .024). There was a trend for a larger upper lip surface area, but not statistically significant (P = .109). Symptoms of slight perioral muscular palsy and mouth incompetence lasted about one month in three patients.

Conclusion: BTA helps to enlarge the upper lip and shorten the philtrum. The BTA injection can be an option for lip enhancement with caution.
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http://dx.doi.org/10.1111/jocd.13731DOI Listing
January 2021

Will the patient's double eyelid shape be like that of the surgeon performing the procedure? A study of surgeons' aesthetics in East Asian Blepharoplasty.

J Cosmet Dermatol 2021 Apr 16;20(4):1208-1213. Epub 2020 Sep 16.

Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Background: No reports of the potential areas of surgeons' aesthetics in blepharoplasty.

Aims: To explore the association between the surgeons' own double eyelid morphology and their aesthetics and surgical outcome.

Methods: An investigation of 1605 patients was carried collecting the data of double eyelid shape, based on which to propose a preliminary double eyelid classification for analyzing the aesthetics of surgeons. Ten double eyelid surgical cases were randomly collected from each surgeon according to the inclusion criteria, whose double eyelid shape, ideal shape, the selection tendency of surgical approach, most cared factor during surgery, and design concept of eyelid shape were collected. Structural equation modeling (SEM) was performed to assess the association between participants' double eyelid shape, aesthetics, and blepharoplasty outcome.

Results: Fifty-three double eyelid surgeons were enrolled for study, whose double eyelids shapes mostly were obviously fan-shaped (37.74%) and low-parallel eyelid (26.42%), and the ideal shapes were obviously fan-shaped (41.51%) and high-parallel eyelid (24.53%). 54.72% of the subjects preferred to use the full-incisional method. 45.28% cared for long-term outcome most. Regarding blepharoplasty outcome style, 49.06% of the subjects preferred obviously fan-shaped type and 24.53% for high-parallel type. SEM showed that aesthetics rank increased by 0.692 points for surgeons' shape (P < .001), and surgical outcome rank increased by 0.861 points for aesthetics (P < .001). However, their eyelid shape had no direct contribution to surgical outcome (P = .96).

Conclusions: The findings indicated that surgeons' double eyelid shape positively affected their aesthetics, which affected their surgical outcomes further, but their double eyelid shape failed to affect the surgical outcomes directly.
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http://dx.doi.org/10.1111/jocd.13699DOI Listing
April 2021

Three-dimensional anthropometric analysis of eyelid aging among Chinese women.

J Plast Reconstr Aesthet Surg 2021 01 12;74(1):135-142. Epub 2020 Aug 12.

Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China. Electronic address:

Background: Eyelid morphology is highly susceptible to aging. Previous studies have described the process of eyelid aging in Caucasians; however, anthropometric data describing aging in Chinese eyelids are lacking. Therefore, this study aimed to quantitatively analyze the effect of aging on the eyelids of Chinese women through a three-dimensional (3D) anthropometry.

Methods: In this prospective, cross-sectional study, 3D photos were captured from 188 healthy Chinese Han women, who were categorized into four age groups. Anthropometric landmarks were identified for the measurement of eyelid parameters, and a unified coordinate system was built into each subject. Linear and angular measurements were computed from the coordinates and were compared between the groups.

Results: An age-related decrease was observed in the ocular width, outer canthal width, palpebral fissure height, and multiple angular measurements. This indicated upper eyelid ptosis, which reduced the lateral and superior visual field. Lateral shift of the upper eyelid arc was not observed. The lower eyelid underwent slight elevation with increasing age. Aging rendered the periorbital region esthetically less pleasing, as shown by changes in the multiple proportion indices computed. Furthermore, an intergroup comparison indicated that eyelid aging was accelerated after the age of 40 years among Chinese women.

Conclusion: This study used 3D photography to quantitatively analyze how eyelids in Chinese women changed with age. The anthropometric data collected could help with antiaging cosmetic surgery planning and postoperative assessment.
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http://dx.doi.org/10.1016/j.bjps.2020.08.010DOI Listing
January 2021
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