Publications by authors named "Sheng-Kang Luo"

27 Publications

  • Page 1 of 1

Three-Dimensional Computed Tomography Scanning of Temporal Vessels to Assess the Safety of Filler Injections.

Aesthet Surg J 2021 Feb 27. Epub 2021 Feb 27.

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.

Background: Temple filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon.

Objectives: This study aimed to investigate the anatomy of the temporal vessels and provide a more accurate protocol for temple filler injection.

Methods: Computed tomography (CT) scans of 56 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3-dimensional (3D) images of the temporal vessels described by a coordinate system based on the bilateral tragus and right lateral canthus.

Results: In the XOY plane, the superficial temporal artery (STA), middle temporal artery (MTA), zygomatico-orbital artery (ZOA), posterior branch of the deep temporal artery (PDTA), and lateral margin of the orbital rim divide the temple into 4 parts (A, B, C, and D). The probabilities of the STA, MTA, ZOA, and PDTA appearing in parts A, B, C, and D were 30.73%, 37.06%, 39.48%, and 77.18%, respectively. In 3D images, these vessels together compose an arterial network that is anastomosed with other vessels, such as the external carotid, facial, and ocular arteries.

Conclusions: 3D CT images can digitally elucidate the exact positions of temporal vessels in a coordinate system, improving the safety of temple filler injections in a clinical setting.
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http://dx.doi.org/10.1093/asj/sjaa371DOI Listing
February 2021

Deployment of the Ophthalmic and Facial Angiosomes in the Upper Nose Overlaying the Nasal Bones.

Aesthet Surg J 2021 Jan 9. Epub 2021 Jan 9.

Department of Plastic and Reconstructive Surgery, Department of Radiology, Guang Dong Second Provincial General Hospital, Guangzhou City, China.

Background: Nasal filler placement is associated with a high risk of blindness. The arterial supply to the upper nose overlaying the nasal bones is poorly understood.

Objectives: This study attempts to visualize and analyze the deployment of the ophthalmic and facial angiosomes in the upper nose and help prevent blindness in nasal filler injections.

Methods: The arterial systems of 62 cadaveric heads were filled with lead oxide contrast, and computed tomography (CT) images were acquired and reconstructed in three-dimensions.

Results: Twenty-six of the cadaveric noses examined demonstrated clear CT images for the facial and ophthalmic angiosomes in the upper nose. The Type 1 upper nose (15.4 percent) is supplied by two independent ophthalmic angiosomes that communicate indirectly through choke anastomosis. The Type 2 upper nose (38.5 percent) is supplied by two ophthalmic angiosomes with true anastomosis between them. The Type 3 upper nose (46.1 percent) is supplied by both ophthalmic and facial angiosomes with true anastomoses across the dorsal midline. These true anastomoses are mediated by the radix arcade in 46 percent of the noses and involve the dorsal nasal artery in 65 percent of the cases. The anastomoses all cross the upper dorsal midline and are directly linked to the ophthalmic angiosome.

Conclusions: The deployment and anastomosis of the facial and ophthalmic angiosomes in the upper nose fall into three major patterns. About 85 percent of the noses have true anastomotic arteries that cross the upper dorsal midline and are directly linked to the ophthalmic circulation. Dorsum filler injection poses a significant risk of blindness.
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http://dx.doi.org/10.1093/asj/sjab003DOI Listing
January 2021

Internal Mastopexy: A Novel Method of Filling the Upper Poles During Dual-Plane Breast Augmentation Trough Periareolar Incision.

Aesthetic Plast Surg 2021 Jan 8. Epub 2021 Jan 8.

Department of Plastic and Reconstructive Surgery, Guangdong Province, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, 510317, China.

Background: Breast ptosis is a deformity commonly found in patients seeking breast augmentation. Current mastopexy techniques rely on incisions on the breast to correct ptosis; nonetheless, they leave extensive scars. Having to opt for a visibly scarred breast over a ptotic breast can be a difficult choice.

Objectives: We sought an innovative internal suture mastopexy for hypomastia of mild breast ptosis.

Methods: A procedure that left a tiny scar on the nipple-areolar complex was introduced. This method was safe and efficient when combining mastopexy with augmentation.

Results: Overall, 53 patients underwent this operation in the Plastic and Cosmetic Department of Guangdong Second Provincial General Hospital from January 1, 2013, to June 30, 2017, with a mean follow-up of 38 ± 16 months. The pre-operation and post-operation SN-N lines (the distance from the sternal notch to the nipple) were 21.8 ± 1.2 cm and 20.7 ± 1.0 cm, respectively; the difference was statistically significant (P<0.05). The patients and surgeon expressed satisfaction with the procedure.

Conclusion: Based on the results of the present study, which included more than 50 patients, we believe that internal suture mastopexy can be used as an effective alternative hypomastia in patients with mild breast ptosis.

Level Of Evidence Iv: 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/s00266-020-02098-yDOI Listing
January 2021

Injectable Filler Technique for Face Lifting Based on Dissection of True Facial Ligaments.

Aesthet Surg J 2020 Dec 10. Epub 2020 Dec 10.

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, China.

Background: Strengthening weakened ligament tissues with injectable fillers to improve their supportive effect may achieve the aesthetic goal of face lifting.

Objectives: The aim of our study was to design an injectable technique for enhancing the true facial ligaments and dissect the ligaments to provide anatomical guidance for effective injection.

Methods: Six true facial ligaments were chosen as target anatomical sites for injection. Specimens were dissected, and three-dimensional images were reconstructed to confirm the exact location of each injection site and to confirm that the proposed injection routes will not cause dangerous vascular damage. A total of five patients received the injections; three-dimensional images were taken before and after the injections for comparison and clinical outcome assessments.

Results: The injection technique was designed to target six true facial ligaments, as follows. Site 1 targeted the temporal ligamentous adhesion region to lift the lateral ends of the eyebrows. Site 2 targeted the region of the lateral orbital thickening to lift the lateral canthus. Site 3 and site 4 targeted the zygomatic retaining ligaments and zygomatic cutaneous ligaments, respectively, to augment the soft tissues of the midface. Site 5 targeted the region of the maxillary ligament to lessen the nasolabial folds, and site 6 targeted the mandibular ligament to reduce the marionette line.

Conclusions: This site-specific injection technique targeting the true ligaments may lead to increased efficiency and accuracy of face rejuvenation and exert a lifting effect.
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http://dx.doi.org/10.1093/asj/sjaa348DOI Listing
December 2020

Three-Dimensional Computed Tomographic Study on the Vessels of the Zygomatic Region: Arterial Variations and Clinical Relevance.

Plast Reconstr Surg 2021 Feb;147(2):328-336

From the Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial People's Hospital.

Background: Injection-based techniques for "cheek augmentation" have gained popularity in recent years. The aim of this study was to perform a topographic analysis of the depth and distribution of the vessels in the zygomatic region to facilitate clinical procedures.

Methods: The external carotid arteries of seven cadaveric heads were infused with lead oxide contrast medium. The facial and superficial temporal arteries of another 12 cadaveric heads were injected sequentially with the same medium. Computed tomographic scanning was then performed, and three-dimensional computed tomographic scans were reconstructed using validated algorithms.

Results: The vessels on the zygomatic arch received a double blood supply from across the upper and lower borders of the arch, and the number of the vessels varied from one to four. Ninety percent of the vessels on the zygomatic arch were at a depth of 1 to 2.5 mm, and 75 percent were at a depth of 10 to 30 percent of the soft-tissue thickness. The vessels were concentrated on the midline of the zygomatic arch and the lateral margin of the frontal process. All samples showed a vessel travel along the lateral margin of the frontal process that eventually merged into the superior marginal arcades.

Conclusions: This study reported a topographic analysis of the depth and distribution of the vessels in the zygomatic region based on three-dimensional scanning. The results indicated that injection on the zygomatic arch should be performed deep to the bone, and the vascular zones anterior or posterior to the midline of the zygomatic arch were relatively safe injection areas.
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http://dx.doi.org/10.1097/PRS.0000000000007519DOI Listing
February 2021

Tomography of the Forehead Arteries and Tailored Filler Injection for Forehead Volumizing and Contouring.

Dermatol Surg 2020 12;46(12):1615-1620

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, People's Republic of China.

Background: The forehead is a challenging area for filler injection because of the risk of serious complications. Anatomy-based filler injection techniques help to avoid severe vascular complications.

Materials And Methods: Sixty-six cadaver heads were infused with adequate lead oxide contrast through the external carotid arteries, internal carotid arteries, facial artery, and superficial temporal artery. Three-dimensional computed tomography scans were reconstructed using validated algorithms. We measured the length and arc length of "beautiful" foreheads evaluated by 3 skilled surgeons.

Results: The frontal branch of the superficial temporal artery (FBSTA) was classified based on the main trunk as follows: Type I FBSTA (89.72%) took a sudden turn (89.56° ± 11.76°) once passing through the temporal crest, whereas Type II FBSTA (10.28%) barely turned (52.26° ± 6.81°) at the temporal crest. A total of 319 arteries passed through the midline in 48 cadaver heads. There were more superficial arteries (292 of 319) than deep arteries (27 of 319). The difference in the length and arc length of the forehead was 19.66 ± 4.35 mm.

Conclusion: This study introduces an effective technique for forehead filler injection that minimizes the risk of filler injection and improves patient satisfaction.
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http://dx.doi.org/10.1097/DSS.0000000000002561DOI Listing
December 2020

A case series: 3-dimensional computed tomographic study of the superior orbital vessels: Superior orbital arcades and their relationships with the supratrochlear artery and supraorbital artery.

J Am Acad Dermatol 2020 Jun 24. Epub 2020 Jun 24.

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, People's Republic of China; Second School of Clinical Medicine, Southern Medical University, Guangzhou City, People's Republic of China. Electronic address:

Background: Vascular complications from periorbital intravascular filler injection are major safety concerns.

Objective: To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections.

Methods: Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm.

Results: Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries.

Limitations: The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection.

Conclusion: This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.
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http://dx.doi.org/10.1016/j.jaad.2020.06.082DOI Listing
June 2020

Microenvironmental Changes in the Surviving Fat 1 Year After Autologous Fat Transplantation for Breast Augmentation.

Aesthet Surg J 2021 02;41(3):NP127-NP133

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, China.

Background: Autologous fat is currently one of the most commonly used soft tissue materials in plastic surgery, but the changes that occur in fat after transplantation are unclear. Existing studies on the changes in surviving fat mostly involve animal experiments.

Objectives: The aim of this study was to obtain surviving fat 1 year after clinical autologous fat transplantation for breast augmentation, to explain the microenvironmental changes after fat transplantation from a clinical perspective, and to verify previous research conclusions, thus providing new insight into fat survival.

Methods: Samples of surviving fat were obtained from 5 patients 1 year after they had undergone autologous fat transplantation for breast augmentation, and normal fat samples were obtained from 5 patients who had not undergone this procedure. The differences between CD68 and CD31 were analyzed immunohistochemically, and between CD34 and Ki67 by immunofluorescence. We also tested whether UCP-1 is expressed in surviving fat.

Results: The relative CD68, CD34, and Ki67 expression levels in the surviving fat tissue were significantly higher than those in the normal fat tissue (PCD68 = 0.04, PCD34 = 0.03, PKi67 = 0.02). The relative CD31 expression was not significantly different between the two groups (P = 0.52). No UCP-1 expression was observed in any surviving fat tissue.

Conclusions: Chronic inflammatory reactions mediated by macrophages were detectable 1 year after autologous fat transplantation for breast augmentation. The mesenchymal stem cell content in surviving fat was higher than that in normal fat, but the number of blood vessels was close to that in normal breast fat tissue. No genesis of brown fat was found.

Level Of Evidence: 5:
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http://dx.doi.org/10.1093/asj/sjaa156DOI Listing
February 2021

Three-Dimensional Analysis of Age-Related Orbital and Midfacial Bone Remodeling in Asians.

Dermatol Surg 2020 12;46(12):e139-e145

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, China.

Background: Facial bony changes vary among races, yet few studies have been conducted in Asians.

Objective: To analyze the aging of orbital and midfacial bones in Asians.

Methods: Based on the two-dimensional data obtained from the computed tomography scanner of imaging department, 3D reconstructions were conducted to take measurements (orbital diagonal diameter, orbital width, orbital area, maxillary angle, midfacial height, pyriform angle, pyriform width, and pyriform area).

Results: In this retrospective study of 261 subjects, a significant decrease in the orbital diagonal diameter, orbital width, and midfacial height was found in men, whereas women displayed a significant increase in the pyriform width and a significant decrease in maxillary angle and midfacial height by three-dimensional analysis.

Conclusion: This study verifies the minor female changes in the orbital region and less dramatic male changes in the midfacial region compared with that in Caucasians. Individualized treatment should be performed according to different genders and races. Further exploration of facial bone metabolism may have valuable implications for Asians.
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http://dx.doi.org/10.1097/DSS.0000000000002399DOI Listing
December 2020

Improvement of Surgical Scars by Early Intervention With Carbon Dioxide Fractional Laser.

Lasers Surg Med 2020 02 8;52(2):137-148. Epub 2019 Jul 8.

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou City, Guangdong Province, 510317, China.

Background And Objectives: Laser therapy during the early stage of wound healing can reduce surgical scar formation. Previous clinical trials showed that ablative fractional laser (AFL) therapy might have achieved the best outcomes; however, there was no consensus on the laser therapy protocol. The current study investigated the efficacy of early intervention with carbon dioxide FL (CO FL) in reducing the surgical scars in patients of all age groups to understand the effects of specific intervention timing, light dose, number of treatments, treatment interval on the therapeutic outcome, and side effects.

Study Design/materials And Methods: Within 1 week after suture removal, 18 patients received low-energy CO FL therapy on their incisional wounds from facial or neck surgery. The treatments were performed once every 3 months for 1-3 sessions. After the surgical treatment, we applied a topical gel that contained recombinant human epidermal growth factor (EGF) on the incisional wounds to facilitate wound healing. The outcomes were evaluated by the Vancouver Scar Scale (VSS) and a satisfaction survey (the quartile grading scale) before and 3 months after completing the therapy was conducted. During the same period, 15 patients who had not received any treatment for about one year after face and neck surgery were randomly selected as the untreated control group.

Results: In the treatment group, 18 patients had no obvious scar marks after the laser therapy. The satisfaction survey showed excellent outcomes in 16 (88.9%) patients and good outcomes in two (11.1%). After treatment, the average VSS scale and satisfaction score of the treatment group were 1.11 and 3.89, respectively; while the average VSS scale of the control group was 3.07 and the satisfaction score was 1.93. There were significant differences in VSS scale and satisfaction score between the treatment group and the control group (P < 0.01). No adverse effects were observed.

Conclusions: Early intervention with CO FL on surgical wounds achieved satisfactory outcomes in improving the surgical scars. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.23129DOI Listing
February 2020

Experimentally Induced Arterial Embolism by Hyaluronic Acid Injection: Clinicopathologic Observations and Treatment.

Plast Reconstr Surg 2019 Apr;143(4):1088-1097

From the Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital; and the Southern Medical University.

Background: Although major complications of hyaluronic acid injection rarely occur, with the rapidly growing number of procedures performed and their expanding applications, such complications warrant greater attention. Our study was designed to explore optimal treatment methods for hyaluronic acid-related vascular occlusion.

Methods: In the first part of the study, 60 rats were given intraarterial hyaluronic acid injected into the bilateral inferior epigastric arteries to establish an animal model, and were euthanized at different postinjection time points. The inferior epigastric artery was retrieved for pathologic examination. In the second part of the study, bilateral abdominal flaps supplied by the inferior epigastric artery were elevated in six groups of rats, and hyaluronic acid was injected into the right side, with each group receiving a different intervention. The flap survival rate was calculated and analyzed.

Results: In the first part of the study, pathologic examination revealed that the composition of the emboli caused by arterial hyaluronic acid-induced occlusion changed from pure hyaluronic acid to a hyaluronic acid-thrombus mixture. In the second part of the study, flap survival rates (mean percentages) were as follows: group A, 43.29 ± 9.28 percent; group B, 54.17 ± 10.86 percent; group C, 59.27 ± 13.40 percent; group D, 64.37 ± 8.61 percent; group E, 71.92 ± 19.06 percent; and group F, 57.47 ± 13.64 percent. Group A differed significantly from groups B, C, D, and E (p < 0.001). No significant difference was observed between groups A and F (p > 0.05).

Conclusions: The combined use of intravenous or subcutaneous hyaluronidase and urokinase was most effective in treating hyaluronic acid injection-related arterial embolism after 45 minutes and 24 hours. This treatment may be ineffective after 48 hours.
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http://dx.doi.org/10.1097/PRS.0000000000005456DOI Listing
April 2019

Optimal Use Ratio of the Stromal Vascular Fraction (SVF): An Animal Experiment Based on Micro-CT Dynamic Detection After Large-Volume Fat Grafting.

Aesthet Surg J 2019 05;39(6):NP213-NP224

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, China.

Background: The addition of the stromal vascular fraction (SVF) can enhance the postoperative survival rate of fat. However, a universal SVF application method is currently unavailable. Therefore, a simple and convenient guideline for SVF addition is needed for its clinical application.

Objectives: The authors sought to evaluate whether SVF can improve fat survival after large-volume fat grafting and to find a simple and convenient standard for the clinical use of SVF.

Methods: Patient fat samples were obtained after liposuction for SVF preparation and grafting. Four types of grafts were prepared with different SVF ratios: 0:1, 1:1, 2:1, and 4:1 SVF:fat. After intensive mixing, fat grafts (5 mL) were randomly injected into both sides of the backs of athymic rats (n = 15). At 24 hours and 1, 3, 6, and 9 months after the operation, microcomputed tomography scanning was performed to calculate the fat survival rate.

Results: Nine months after the operation, the survival rates of fat in the 4 groups were 8.89 ± 1.62% (0:1), 18.26 ± 3.85% (1:1), 8.83 ± 1.46% (2:1), and 7.96 ± 1.31% (4:1). The 1:1 group exhibited the greatest survival rate (P < 0.01), and the adipose tissue histological patterns and blood vessel quality were enhanced compared with those in the other groups.

Conclusions: An appropriate SVF ratio can increase the fat survival rate after large-volume fat grafting, but no linear relationship exists between the SVF ratio and fat survival. The optimal SVF:fat ratio for grafting is 1:1.
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http://dx.doi.org/10.1093/asj/sjy266DOI Listing
May 2019

Three-Dimensional Computed Tomographic Study on the Periorbital Branches of the Ophthalmic Artery: Arterial Variations and Clinical Relevance.

Aesthet Surg J 2019 09;39(10):1109-1117

Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.

Background: Filler injection is a popular cosmetic procedure, but it can entail vascular complications. Periorbital injections have the highest risk within the entire injection area.

Objectives: The authors sought to systematically screen for periorbital arterial variations prior to treatment.

Methods: The external carotid arteries of 10 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 11 cadaveric heads were injected with the contrast in sequential order. Computed tomography (CT) scanning was performed after injection of contrast, and 3-dimensional (3D) CT scans were reconstructed using validated algorithms.

Results: Three types of periorbital blood vessels were found to derive from the ophthalmic artery, including 30% directly originating from the ophthalmic artery, 65% originating from its trochlear branch, and 5% originating from its supraorbital branch. In the forehead, the ophthalmic artery, originating from the internal carotid arteries, formed anastomoses between the frontal branch of the superficial temporal artery, originating from the external carotid artery, with the deep and superficial branches of the supratrochlear and supraorbital arteries, respectively. The lateral orbit and malar plexus can be classified into 4 types based on the trunk artery: the zygomatic orbital artery (27%), the transverse facial artery (23%), the premasseteric branch of the facial artery (19%), and all 3 contributing equally (31%).

Conclusions: Postmortem 3D CT can map periorbital arterial variations. The branching pattern of the ophthalmic artery, the ophthalmic angiosome in the forehead, and the distribution of the lateral orbit and malar plexus were identified at high resolution to guide clinical practice.
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http://dx.doi.org/10.1093/asj/sjy228DOI Listing
September 2019

High-Throughput Screening of Full-Face Clinically Relevant Arterial Variations Using Three-Dimensional Postmortem Computed Tomography.

Plast Reconstr Surg 2018 11;142(5):653e-664e

From the Departments of Plastic and Reconstructive Radiology, Guangdong Second Provincial General Hospital.

Background: Vascular complications resulting from intravascular filler injection and embolism are major safety concerns for facial filler injection. It is essential to systematically screen full-face arterial variations and help design evidence-based safe filler injection protocols.

Methods: The carotid arteries of 22 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 12 cadaveric heads were injected with the contrast in a sequential order. A computed tomographic scan was acquired after each contrast injection, and each three-dimensional computed tomographic scan was reconstructed using validated algorithms.

Results: Three-dimensional computed tomography clearly demonstrated the course, relative depth, and anastomosis of all major arteries in 63 qualified hemifaces. The ophthalmic angiosome consistently deploys two distinctive layers of branch arteries to the forehead. The superficial temporal and superior palpebral arteries run along the preauricular and superior palpebral creases, respectively. The study found that 74.6 percent of the hemifaces had nasolabial trunks coursing along the nasolabial crease, and that 50.8 percent of the hemifaces had infraorbital trunks that ran through the infraorbital region. Fifty percent of the angular arteries were the direct anastomotic channels between the facial and ophthalmic angiosomes, and 29.2 percent of the angular arteries were members of the ophthalmic angiosomes.

Conclusions: Full-face arterial variations were mapped using postmortem three-dimensional computed tomography. Facial creases were in general correlated with underlying deep arteries. Facial and angular artery variations were identified at high resolution, and reclassified into clinically relevant types to guide medical practice.
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http://dx.doi.org/10.1097/PRS.0000000000004834DOI Listing
November 2018

Facial Volume Restoration with Permanent Dermal Filler (Artecoll-4) in Chinese Women.

Facial Plast Surg 2017 Oct 29;33(5):537-544. Epub 2017 Sep 29.

Division of Plastic Surgery, University of California, San Diego, California.

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http://dx.doi.org/10.1055/s-0037-1605599DOI Listing
October 2017

Efficacy of Retrobulbar Hyaluronidase Injection for Vision Loss Resulting from Hyaluronic Acid Filler Embolization.

Aesthet Surg J 2017 Dec;38(1):12-22

Department of Plastic and Reconstructive Surgery and the Department of Ophthalmology, Guangdong Second Provincial People's Hospital, China.

Background: Vision loss is a rare but serious complication of facial hyaluronic acid (HA) filler injection, for which there is no proven rescue therapy. Retrobulbar hyaluronidase injection is advocated by many plastic surgeons as an emergency treatment, but has not been carefully assessed for its efficacy.

Objectives: To evaluate the efficacy of retrobulbar hyaluronidase injection as a rescue treatment for vision loss caused by HA filler embolization.

Methods: Patients with vision loss caused by HA filler embolization were treated with retrobulbar hyaluronidase injection. Their visual acuity and fundoscopic images before and after treatment were analyzed for efficacy assessment.

Results: One patient with branch retinal artery occlusion (BRAO), one patient with posterior ischemic optic neuropathy (PION), one patient with ophthalmic artery occlusion, and one patient with both BRAO and PION were treated with one or two retrobulbar injections of 1500 or 3000 units hyaluronidase. No patients demonstrated substantial retinal artery recanalization or vision acuity improvement after treatment.

Conclusions: One or two retrobulbar injections of 1500 to 3000 IU hyaluronidase are unable to recanalize retinal artery occlusion or improve the visual outcome of patients who presented with vision loss caused by HA filler embolization at least four hours after onset.

Level Of Evidence: 4.
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http://dx.doi.org/10.1093/asj/sjw216DOI Listing
December 2017

Clinical Outcomes of Impending Nasal Skin Necrosis Related to Nose and Nasolabial Fold Augmentation with Hyaluronic Acid Fillers.

Plast Reconstr Surg 2015 Oct;136(4):434e-441e

Guangzhou City, People's Republic of China From the Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial People's Hospital.

Background: Although there are several case reports of facial skin ischemia/necrosis caused by hyaluronic acid filler injections, no systematic study of the clinical outcomes of a series of cases with this complication has been reported.

Methods: The authors report a study of 20 consecutive patients who developed impending nasal skin necrosis as a primary concern, after nose and/or nasolabial fold augmentation with hyaluronic acid fillers. The authors retrospectively reviewed the clinical outcomes and the risk factors for this complication using case-control analysis.

Results: Seven patients (35 percent) developed full skin necrosis, and 13 patients (65 percent) recovered fully after combination treatment with hyaluronidase. Although the two groups had similar age, sex, filler injection sites, and treatment for the complication, 85 percent of the patients in the full skin necrosis group were late presenters who did not receive the combination treatment with hyaluronidase within 2 days after the vascular complication first appeared. In contrast, just 15 percent of the patients in the full recovery group were late presenters (p = 0.004).

Conclusions: Nose and nasolabial fold augmentations with hyaluronic acid fillers can lead to impending nasal skin necrosis, possibly caused by intravascular embolism and/or extravascular compression. The key for preventing the skin ischemia from progressing to necrosis is to identify and treat the ischemia as early as possible. Early (<2 days) combination treatment with hyaluronidase is associated with the full resolution of the complication.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000001579DOI Listing
October 2015

Anatomic study of selective neurectomy of gastrocnemius muscle for calf reduction in Chinese.

J Plast Reconstr Aesthet Surg 2013 Jun 4;66(6):e162-5. Epub 2013 Apr 4.

Department of Cosmetic and Plastic Surgery, The Second People's Hospital of Guangdong Province, Guangzhou, China.

Background: Selective neurectomy of the innervating nerves of the gastrocnemius muscle is a popular method employed for calf reduction. However, accidental injury to the untargeted adjacent nerves could happen. This study aims to provide detailed morphometry of the motor branches from the tibial nerve innervating the gastrocnemius muscle, the soleus and the medial sural cutaneous nerve in the popliteal fossa.

Methods: 23 lower legs from female cadavers were dissected to explore the origin, length of and the spatial relationship between the four branches given off from the tibial nerve in the popliteal fossa.

Results: Our study showed there were seven origin patterns existing among the four nerve branches; the origin of the branches to the medial and lateral heads of the gastrocnemius muscle was located ranging from -16 mm to 22 mm away from the midpoint of the line between the lateral and medial condyles of the femur; In 95% of the specimens, the location of the origin of the nerve branch to the medial head was proximal to its lateral counterpart. The nerve to the medial head was often given off from the medial aspect or the posteromedial aspect of the tibial nerve, while the other three often from the lateral aspect.

Conclusions: A variety of origin patterns among the nerves to the lateral and medial gastrocnemius muscle, the nerve to the soleus muscle and the sural cutaneous nerve exist, necessitating the formulation of diversifying surgical strategies preoperatively and the meticulous and sequential dissection intra-operatively to ensure the lowest level of accidental injury.
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http://dx.doi.org/10.1016/j.bjps.2013.02.001DOI Listing
June 2013

[Combined treatment with areola approach for capsular contracture after breast augmentation with implants].

Zhonghua Zheng Xing Wai Ke Za Zhi 2012 Sep;28(5):321-4

Department of Plastic Surgery, Guangdong Provincial Second People's Hospital, Guangzhou 510317, China.

Objective: To investigate the combined treatment with areola approach for capsular contracture after breast augmentation with implants.

Methods: From Feb. 2005 to Jun. 2011, 94 cases (168 sides) with Baker III and IV capsular contracture after breast augmentation with implants were treated with areola approach. The implants cavity was recreated, with or without removal of capsule. The implants were reimplanted behind pectoralis major or breast at the second stage in some patients.

Results: 46 cases were followed up by clinic visit and the others were followed up by telephone for 6-37 months, with an average of 9.9 months. The capsular contracture was relapsed in 2 cases as Baker III and 1 case as Baker IV. All the other breasts got a good appearance with good soft texture and feeling. No hematoma, infection, implants rupture, breast ptosis or implant displacement happened.

Conclusions: Combined treatment with areola approach has a good therapeutic effect for capsular contracture after breast augmentation with implants. The breast appearance is satisfactory with low occurrence of capsular contracture.
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September 2012

Our strategy in complication management of augmentation mammaplasty with polyacrylamide hydrogel injection in 235 patients.

J Plast Reconstr Aesthet Surg 2011 Jun 11;64(6):731-7. Epub 2010 Nov 11.

Department of Aesthetic and Plastic Surgery, Guangdong No.2 Provincial People's Hospital, Guangzhou, PR China.

Polyacrylamide hydrogel (PAAG) was once widely used in breast augmentation in China. Although it had been banned for augmentation mammaplasty in 2006, a large number of patients whose breasts were augmented with the gel injection have continued to seek medical advice because of its complications. The clinical management of these complications has never been standardised. The data of a total of 235 patients with complications following PAAG-injected breast augmentation have been summarised and the types and causations analysed. Magnetic resonance imaging (MRI) was undertaken in 228 patients with palpable masses, breast pain or tenderness, asymmetry or deformity and functional or psychological problems to eliminate neoplasm, infection and to delineate the diseases. The surgical gel evacuation via periareolar incisions was performed for all patients and immediate silicone breast prostheses were implanted in 108 patients and were delayed in 28 cases by 6 months. Most patients (214/235) of the group were satisfied with the treatment, and symptoms disappeared after removal of the gel. The gel distribution and involved tissue were well defined and neoplasm was ruled out by MRI. Postoperative MRI in 68 patients revealed that no obvious PAAG remaining. In either immediate or delayed reconstructive patients with silicone breast implants, good breast contour presented. A diagnosis and management strategy for these complications is proposed. In conclusion, the breast masses, pain and deformity are major complications after PAAG-injected breast augmentation. Psychological problems should be paid attention to. MRI is a sensitive and accurate method for diagnosis and treatment evaluation. Surgical removal of injected gel is the preferred method for complication management. The implantation of silicone prostheses for breast contour restoration after PAAG evacuation is effective for patients under strict selection. Our strategy for treating PAAG-related complications proved useful.
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http://dx.doi.org/10.1016/j.bjps.2010.10.004DOI Listing
June 2011

Late hematoma, seroma, and galactocele in breasts injected with polyacrylamide gel.

Aesthetic Plast Surg 2011 Jun 12;35(3):365-72. Epub 2010 Nov 12.

Department of Plastic Surgery, First Affiliated Hospital, College of Clinical Medicine, Guangdong Pharmaceutical University, Nonglinxialu 19, Guangzhou, China.

Late hematoma or seroma and galactocele caused by augmentation mammaplasty have been reported in patients with silicon breast prostheses but are extremely rare in patients injected with polyacrylamide gel (PAAG). In a retrospective survey, the incidence, clinical manifestations, and management of late hematoma, seroma, and galactocele in 28 of 2,610 patients who underwent breast augmentation with PAAG injection were investigated, and 5 typical cases are presented. The diagnostic and managing methods for this complication have been assessed. The incidence of late hematoma or seroma was 0.65% and that of galactocele was 0.35% among patients with PAAG-injected breast augmentations. The clinical onsets of such late PAAG complications were of two types: rapid enlargement in 17 patients and progressive expansion in another 11 patients. Aspiration, ultrasound, and magnetic resonance imaging (MRI) are useful and sensitive tools for diagnosis. Foreign body reaction, PAAG-related tissue necrosis and fibrosis, and granuloma were shown, and the bacterial cultures in all 12 cases were negative. Needle aspiration with pressure dressing has been advocated as a reliable method for small diseases, and surgical exploration with irrigation-vacuum drainage and evacuation with capsulectomy have been considered more effective for recurrent, large, and long-term cases. In conclusion, these late complications rarely present after large-volume injections of PAAG for breast augmentation. The PAAG-related pathologic inflammatory tissue changes are suggested as the pathogenesis for the complication. Trauma and breastfeeding are considered to be stimulating factors.
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http://dx.doi.org/10.1007/s00266-010-9617-4DOI Listing
June 2011

Treatment of infantile hemangioma with optimal pulse technology.

J Cosmet Laser Ther 2010 Jun;12(3):145-50

Department of Plastic Surgery, Guangdong Second Provincial People's Hospital, Guangzhou Guangdong, PR China.

Background And Objective: The treatment of infantile hemangioma must address both the effectiveness of the treatment and have as few adverse events as possible for the patient as a result of the therapy. The intense pulsed light (IPL) source can be useful in this regard in treating infantile hemangioma. IPL with optimal pulse technology (OPT) represents a new generation of IPLs and in this clinical investigation, the efficacy and adverse event profiles of treating infantile hemangiomas with an IPL with OPT will be reviewed.

Methods: A total of 62 patients with infantile hemangiomas were included in this clinical trial. The mean age of the patients was 6 months old. The Fitzpatrick skin types for those enrolled was either Type III or Type IV. Each patient was subjected to a treatment protocol which included four to five IPL treatments at 4-week intervals. The patients were then assessed at 3 months following their last IPL treatment and clinical improvement was determined by comparisons of pre- and post-therapy photographs. The parents of the patients were asked to score their overall satisfaction with the treatments.

Results: From the clinical trial presented, 76% of the infantile hemangiomas were noted to improve with great satisfaction in this clinical trial. A clearance rate of more than 80% was observed. Adverse events, as a result of the IPL treatment, was minimal with less than 5% of the treatments resulting in an adverse event, all of which were noted to be transient in nature. No scarring or pigmentary disturbances were seen in any of the patients evaluated.

Conclusions: This new generation IPL with OPT can be considered a safe and effective modality for the treatment of infantile hemangioma. Marked improvement was noted in the majority of study patients and adverse events were noted to be minimal.
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http://dx.doi.org/10.3109/14764172.2010.487908DOI Listing
June 2010

[The telomerase activity of human adipose derived stem cells during proliferation and differentiation in vitro].

Zhonghua Zheng Xing Wai Ke Za Zhi 2010 Jan;26(1):48-52

Department of Aestethic and Plastic Surgery, Guangdong No. 2 Provincial People's Hospital, Guangzhou 510317, China.

Objective: To investigate the telomerase activity of human adipose derived stem cells (ADSCs) during proliferation and differentiation in vitro.

Methods: ADSCs were highly purified and cultured in vitro. The morphology, phenotype and biological properties of the cultured ADSCs were observed by flow cytometer. Then ADSCs were induced to differentiate into adipocytes and osteoblast. The telomerase activity was detected by TRAP.

Results: ADSCs had the ability of multi-directed differentiation, like adipocytes and osteoblast. It could also express the stem cell-related surface markers. The telomerase activity was negative or lowly expressed in ADSCs in vitro within 12 generations. The telomerase activity was up-regulated when ADSCs was adipogenic differentiated, but deceased 3-6 days later.

Conclusions: The telomerase activity of ADSCs is not changed during culture in vitro. It is up-regulated when ADSCs are induced to adipogenic differentiation, but decreased later.
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January 2010

[Construction of animal models of keloid by tissue engineering].

Di Yi Jun Yi Da Xue Xue Bao 2005 Jul;25(7):815-9, 832

Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To construct animal model of keloid by using tissue engineering and to explore its potential clinical significance.

Method: Fibroblasts from keloid were isolated and cultured. After being cultured to generation six or eight, fibroblasts were inoculated into scaffolds constructed from copolymers of polylactic acid (PLA) and polyglycolic acid (PGA), and then cultured in rotatory cell culture system for 1 week prior to subcutaneous transplantation into 20 athymic mice. After 4, 8, 16, 24 weeks, the specimens were cut out and examined histologically.

Results: All the mice survived after surgery. The collagen patterns of all the keloids were remained after 24 weeks. A lot of fibroblasts and their secreted collagen were observed under light microscope. Enlarged rough endoplasmic reticula inside the fibroblasts were revealed by transmission electron microscopy. The fibroblasts in specimens remained the capability of synthesizing and secreting collagen. CONCLUSIONS There is a good affinity between PLA/PGA and fibroblasts. Complex of PLA/PGA and fibroblasts could be cultured into keloids in athymic mice.
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July 2005

[Repeated tissue expansion for repairing extensive scalp and facial soft tissue defects: analysis of 18 cases].

Di Yi Jun Yi Da Xue Xue Bao 2005 Apr;25(4):474-5

Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

Objective: To summarize our experiences with 18 cases of repeated tissue expansion for treating extensive scalp and facial soft tissue defects.

Method: Tissue expansion was performed for 1 or 2 times after the primary expansion for repairing large scalp and facial soft tissue defects ranging from 9 cm x 5 cm to 16 cm x 12 cm using re-expanded flaps. The indications, complications and experiences in the treatment were discussed.

Result: Satisfactory results were obtained in all the 18 cases. On the follow-up conducted 6 months postoperatively, the repaired defects presented excellent appearance and functional recovery without additional scars.

Conclusion: Repeated tissue expansion is an effective technique for repairing large tissue defects in the head and face.
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April 2005

[Primary culture of preadipocytes from human adults].

Di Yi Jun Yi Da Xue Xue Bao 2005 Mar;25(3):270-3

Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou China.

Objective: To establish a method for primary culture of human preadipocyte as the seed cells for adipose tissue engineering. METHOSA: Fibroblast-like cells were cultured from adult human abdominal adipose tissue. The morphological changes of the cultured cells were observed and the growth curve drawn. The intracytoplasmic lipid of the cultured cells was determined using oil red O staining. RWSULRS: The cultured fibroblast-like cells showed highly homogeneous appearance with active proliferation, and could differentiate into mature adipocytes. Oil red O staining and morphological and biological observation verified these cells as preadipocytes with accumulation of lipid droplets in the cytoplasm. Extraction of the intracytoplasmic lipid stained with oil red O suggested a rapid increase in the intracytoplasmic lipid content on the 9th day of inoculation, which peaked on day 18.

Conclusions: Preadipocytes are present in mature human adipose tissue and possess the potential to proliferate and differentiate into mature adipocytes. These homogeneous preadipocytes with good proliferating activity can be harvested through primary cell culture.
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March 2005

[Interventional radiologic therapy for arteriovenous malformations in the face].

Zhonghua Zheng Xing Wai Ke Za Zhi 2003 Nov;19(6):413-5

Department of Plastic Surgery, Nanfan Hospital, First Military Medical University, Guangzhou 510515, China.

Objective: To introduce the technique of transarterial interventional embolization treating for arteriovenous malformations (AVM) in the face.

Methods: From April 1998, 17 patients have been treated with this method. Seldinger's maneuver was used in this series. Of them, 11 cases received only interventional embolization; 6 cases received both interventional embolization and surgical resection.

Results: The interventional embolization was effective in all the 17 cases, which was confirmed by immediate angiography. Their clinical symptoms were gradually relieved. Interventional embolization obviously decreased hemorrhage during surgical resection.

Conclusions: Interventional embolization provides a new way for the treatment of AVM. Preoperative embolization can lower the surgical risk as it obviously decreases hemorrhage during the surgical procedure.
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November 2003