Calculating the Thickness of the Superficial Fatty Layer of the Body Using Age, Gender, and Body Mass Index

BACKGROUND: Injections of biostimulator agents are increasing in popularity as an alternative to surgical or energy-based skin tightening procedures. The present study was designed to develop a formula that helps to guide health care providers injecting biostimulators into the correct plane to enhance effectiveness and longevity by targeting precisely the superficial fascial system. METHODS: 150 Caucasian individuals (75 males and 75 females) were investigated with a balanced distribution of age (n=30 per decade: 20­29, 30­39, 40­49, 50­59, and 60­69 years) and body mass index (n=50 per group: BMI≤24.9kg/m2, BMI between 25.0 and 29.9kg/m2 BMI≥30kg/m2). The distance between skin surface and the superficial fascia was measured via ultrasound in the buccal region, premasseteric region, the lateral neck, posterior arm, abdomen, buttocks, anterior thigh, medial thigh, and posterior thigh. RESULTS: Mean thickness of the superficial fatty layer is variable between the different locations investigated with smallest values for the lateral neck of 3.71mm ± 0.55 [range, 2.00­5.00mm] and greatest values for the gluteal region with 20.52mm±10.07 [range, 6.10­38.40mm]. A formula was developed to estimate the thickness of the superficial fatty layer based on the targeted region, age, gender, and body mass index of the patient: Thickness of superficial fatty layer (mm): Region constant + (XX* BMI) - (YY*Age). CONCLUSIONS: Injections of biostimulators deeper than the calculated values might result in reduced efficacy as the superficial fascial system is not targeted and the effected collagen neogenesis does not affect the skin surface. J Drugs Dermatol. 2020;19(1):36-44. doi:10.36849/JDD.2020.4619

Determination of the Pretibial Soft Tissue Thickness in Children: Are Intraosseous Infusion Needles Long Enough?

OBJECTIVE: The EZ-IO intraosseous (IO) needle is available in 2 needle sizes for children based on the patient weight. To date, there is no published evidence validating the use of weight-based scaling in children. We hypothesized that pretibial subcutaneous tissue thickness (PSTT) does not correspond with patient weight but rather with age and body mass index (BMI). Our objective was to describe the relationship of a patient's PSTT to their weight, age, and BMI in children less than 40 kg. METHOD: One hundred patients who weighed less than 40 kg were recruited prospectively from October 2013 to April 2015 at a tertiary care pediatric emergency department. All sonographic assessments were performed by 1 of 2 emergency physicians certified in point-of-care ultrasound. A single sonographic image was taken over the proximal tibia corresponding to the site of IO insertion. In patients where both sonographers performed independent measurements, a Pearson correlation coefficient was determined. Univariate linear regression was performed to determine the relationship between age, weight, and BMI with PSTT. RESULTS: One hundred participants were recruited and ranged in age from 10 days to 14 years (mean [SD], 5.01 [3.14] years). Fifty-seven percent of participants were male. Patients' weights ranged from 3.5 to 39.3 kg (mean [SD], 21.42 [9.12] kg), and BMI ranged from 12.1 to 45.0 kg/m (mean [SD], 17.31 [4.00]). The mean (SD) PSTT across participants was 0.68 (0.2) cm. The intraclass correlation coefficient for agreement between the 2 sonographers was moderate (intraclass correlation coefficient, 0.602 [confidence interval, 0.385-0.757]). There were significant positive correlations between BMI and PSTT (r = 0.562, P = <0.001) as well as weight and PSTT (r = 0.293, P < 0.003). There was a weak correlation between age and PSTT (0.065, P = 0.521). CONCLUSIONS: Pretibial subcutaneous tissue thickness correlates most strongly with BMI, followed by weight, and weakly with age. Our findings suggest that current IO needle length recommendations should be based on BMI rather than weight. This would suggest that clinicians need to be aware that young patients in particular with large BMIs may pose problems with current weight-based needle length recommendations.

A comparative multi-site and whole-body assessment of fascia in the horse and dog: a detailed histological investigation.

Fascia in the veterinary sciences is drawing attention, such that physiotherapists and animal practitioners are now applying techniques based on the concept of fascia studies in humans. A comprehensive study of fascia is therefore needed in animals to understand the arrangement of the fascial layers in an unguligrade horse and a digitigrade dog. This study has examined the difference between the horse and the dog fascia at specific regions, in terms of histology, and has compared it with the human model. Histological examinations show that in general the fascia tissue of the horse exhibits a tight and dense composition, while in the dog it is looser and has non-dense structure. Indeed, equine fascia appears to be different from both canine fascia and the human fascia model, whilst canine fascia is very comparable to the human model. Although regional variations were observed, the superficial fascia (fascia superficialis) in the horse was found to be trilaminar in the trunk, yet multilayered in the dog. Moreover, crimping of collagen fibers was more visible in the horse than the dog. Blood vessels and nerves were present in the loose areolar tissue of the superficial and the profound compartment of hypodermis. The deep fascia (fascia profunda) in the horse was thick and tightly attached to the underlying muscle, while in the dog the deep fascia was thin and loosely attached to underlying structures. Superficial and deep fascia fused in the extremities. In conclusion, gross dissection and histology have revealed species variations that are related to the absence or presence of the superficial adipose tissue, the retinacula cutis superficialis, the localization and amount of elastic fibers, as well as the ability to slide and glide between the different layers. Further research is now needed to understand in more detail whether these differences have an influence on the biomechanics, movements and proprioception of these animals.

Self-massage prior to stretching improves flexibility in young and middle-aged adults.

We examined the influence of stretching alone (SS) or combined with self-massage (SM) on maximal ankle dorsiflexion angle, maximal voluntary contraction (MVC) torque and calf muscle activity, and subcutaneous tissue thickness in 15 young (25 ± 3 years) and 15 middle-aged (45 ± 5 years) adults. Participants performed two sessions of calf muscle stretches (3x 30-s stretches, 30-s rest): stretch after a 60-s control condition (SS) and stretch after 60 s of self-massage with therapy balls (SM). Evaluations were performed before and 5 min after the intervention. Linear mixed effects model revealed no main effect for age on ROM or MVC and significant main effects for treatment and time. Change in ankle angle was greater after SM: SS = 3.1 ± 2°, SM = 6.2 ± 3.3° (Hedges' g = 0.98, p < 0.001). Similar results were observed for MVC torque: SS = -4 ± 16%, SM = 12 ± 16% (Hedges' g = 0.97, p = 0.0001). Changes in MVC torque and absolute EMG amplitude were correlated, but subcutaneous tissue thickness was not altered by treatment. The gains in ROM were more pronounced in less flexible middle-aged adults, underscoring the need to include flexibility exercises in their training.

Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery.

OBJECTIVE: There has been a significant shift in the understanding of facial anatomy during the last decade. Newer minimally invasive therapeutic options for facial rejuvenation procedures are increasing the need for a better knowledge of anatomy. MATERIAL AND METHODS: The current literature is summarized, analyzed and presented along with the experience of the author for this narrative review, which summarizes the current understanding of the superficial and deep facial fat compartments and their relevance for minimally invasive facial procedures. A schematic facial model was created in order to facilitate a better understanding of the complexity of facial anatomy. RESULTS: The face is arranged in five layers as follows: layer 1: skin; layer 2: subcutaneous fat including the retinacula cutis (composed of fibrous connective tissue); layer 3: superficial musculo-aponeurotic system (SMAS); layer 4: deep fat; and layer 5: periosteum or deep fascia. This arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The facial fat compartments are located in layers 2 and 4; each layer has unique characteristics and spatial relationships with the surrounding tissues. CONCLUSIONS: The concept of the layered arrangement is a new way to understand the spatial relationship and functional interplay of the soft tissues of the face. Understanding the layers, the precise location of the superficial and deep facial fat compartments and their boundaries is crucial for the conduct of safe and effective minimally invasive facial procedures.

Superficial Fascia in the Cheek and the Superficial Musculoaponeurotic System.

The origins and validity of the term "superficial musculoaponeurotic system" (SMAS) is reviewed. Gray stated the superficial fascia connects the skin with the deep or aponeurotic fascia and consists of fibro-areolar tissue. Hollinshead wrote superficial fascia exists throughout the body and contains a variable amount of fat. In the head and neck, it encloses voluntary muscles in its deep portion. Skoog found superficial fascia was fixed to the dense, deep fascia by fibrous adhesions in the temporal, preauricular, and parotid area. Mitz stated "There is a 'superficial muscular and aponeurotic system' (SMAS) in the parotid and cheek areas." SMAS has an intimate relationship with the entire superficial fascia of the head and neck and divides the subcutaneous fat into 2 layers. Wassef found a continuous fibromuscular layer at the deep limit of the "subcutis," which corresponded to the "superficial fascia." Nakajima reported the subcutaneous adipofascial tissue was made up of 2 adipofascial layers. Macchi found 2 different fibroadipose connective layers bounded to the laminar connective tissue layer (SMAS). In the cheek, Hwang found horizontal fibrous connective tissues (membranous layer of superficial fascia) divided the superficial fascia into the superficial fatty layer and the deep fatty layer. Recently, Mitz explained the reason for the term SMAS. The "musculo+aponeurotic" component is based on histology of muscle cells, including the risorius, in the same structure to be surgically consistent. The aponeurotic cells belong to the same surgical layer. SMAS is not sufficient to replace the old term "superficial fascia" of the cheek area.

Does Botulinum Toxin Injection into Masseter Muscles Affect Subcutaneous Thickness?

BACKGROUND: Botulinum toxin (BoNT) is widely used to treat masseter muscle hypertrophy. Changes in the muscle thickness have been found in many studies, but there has been no report on changes in the thickness from the skin surface to the masseter muscle. OBJECTIVES: We aimed to use ultrasonography to measure not only changes in the muscle thickness but also changes in subcutaneous thickness. METHODS: This study enrolled 20 volunteer patients: 10 were assigned to an experimental group (injected with each side 25 U of botulinum toxin into both masseter muscles) and 10 to a control group (injected with normal saline). The thicknesses were measured before the injection and at 4, 8, and 12 weeks after the injection both at rest and during maximum muscle contraction. RESULTS: The subcutaneous thickness did not differ significantly over time either at rest (P = 0.063) or during maximal contraction (P = 0.392), or between the experimental and control groups at rest (P = 0.392) or during maximum contraction (P = 0.259). The muscle thickness in the experimental group differed significantly over time. CONCLUSIONS: Botulinum toxin injection only changes the muscle thickness and does not affect the subcutaneous thickness from the skin surface to the masseter muscle.

Analysis of morphological changes after facial massage by a novel approach using three-dimensional computed tomography.

BACKGROUND/PURPOSE: Photograph-based visual scoring has been used for evaluation of facial morphological changes. Here, we describe a three-dimensional computed tomography (3D-CT) method for objective analysis of facial and intra-facial (subcutaneous) changes. The effects of facial massage were examined using both methods. METHODS: Subjects were 12 healthy female volunteers without facial scars or deformation (age 30-54 years, mean 39.4 years). Photograph-based scoring of massage-induced morphological changes was done at the nasolabial folds, upper, lower and lateral cheeks and lower eyelids. For 3D-CT evaluation, the virtual center axis (VCA) was set as the cranio-caudal longitudinal line, and the VCA-skin surface distances (VSDs) were measured. Massage-induced changes of VSD were calculated (facial massage-induced change rate, FMCR). Intra-facial (subcutaneous) changes were also evaluated. RESULTS: Photograph-based scoring revealed marked morphological changes of the nasolabial folds after facial massage, and changes of the lower, upper and lateral cheeks and lower eyelid were also observed in more than half of the subjects. FMCR values were significantly changed in the paranasal area, nasolabial fold area and cranial part of the mandibular area. Photograph-based scores at the lower cheek and lower eyelid were well correlated with FMCR in the inferior part of the nasolabial fold and the mandibular area, respectively. Massage-induced changes of subcutaneous fat tissues and facial expression muscles were also apparent on CT images. CONCLUSION: 3D-CT imaging is useful for objective evaluation of the effects of facial massage, including anatomical changes in subcutaneous structures.

Nasal Anatomy and Function.

The nose is a complex structure important in facial aesthetics and in respiratory physiology. Nasal defects can pose a challenge to reconstructive surgeons who must re-create nasal symmetry while maintaining nasal function. A basic understanding of the underlying nasal anatomy is thus necessary for successful nasal reconstruction.

Bilayered Structure of the Superficial Facial Fascia.

Background: The superficial facial fascia comprises the superficial musculoaponeurotic system (SMAS) and the temporoparietal fascia (TPF) and is regarded as a continuous monolayer. However, some evidence indicates that the superficial facial fascia consists of 2 layers in specific areas. Objectives: The authors evaluated the superficial facial fascia for bilayered regions. Methods: Twenty fresh cadavers (40 hemifaces) were dissected to observe the superficial facial fascia. Twelve cadavers were dissected to assess tensile strengths of the superficial and deep layers of the SMAS. Specimens were obtained from 2 cadavers for histologic analysis. Results: The SMAS and TPF were separable into superficial and deep layers, with intervening areolar tissue. The deep TPF was continuous with the deep SMAS inferiorly and the subgalea anteriorly. The superficial orbicularis oculi was invested by the superficial SMAS, whereas the deep orbicularis and the platysma were invested by the deep SMAS. Thus, 2 key structures addressed in facial rejuvenation are positioned in different surgical planes. Conclusions: Study results support the belief that the superficial facial fascia comprises 2 layers, with the superficial orbicularis oculi and platysma invested by different layers. These findings have implications for facial rejuvenation techniques that involve management of the SMAS and TPF.

Managing the Difficult Soft Tissue Envelope in Facial and Rhinoplasty Surgery.

BACKGROUND: The nasal soft tissue envelope affects the final rhinoplasty result, and can limit the expected improvement. Currently, no dependable and objective test exists to measure the thickness of the nasal skin and underlying soft tissue. OBJECTIVES: This paper presents a simple, yet reliable method to determine the thickness of the soft tissue envelope. An algorithm is presented for treatment of the dermis and/or soft tissue apart from surgery of the underlying osseocartilaginous structures. METHODS: Seventy-five patients presenting for primary rhinoplasty underwent visual and ultrasound assessment of their nasal soft tissue envelope. At preoperative evaluation, the Obagi "skin pinch test" was used to assess the thickness of the nasolabial fold and whether or not the skin was oily. Patients were classified based on the pinch thickness. At time of surgery prior to injection of local anesthesia, ultrasonic assessment was done at the nasolabial fold, keystone junction, supratip, and tip to measure the thickness of the nasal dermis and underlying soft tissue. RESULTS: Patients determined to have thin, normal, and thick skin by the "skin pinch test" were found to have a nasolabial fold dermal thickness with an average of 0.7 mm (0.4-1.2 mm), 1.1 mm (0.8-1.8 mm), and 1.4 mm (0.7-2.0 mm). Patients determined to have thin, normal, and thick skin were found to have a dermal thickness at the keystone junction with an average of 0.3 mm (0.2-0.4 mm), 0.5 mm (0.3-1.1 mm), and 0.9 mm (0.6-1.2 mm), respectively. This difference in thickness also translated to the supratip and tip areas measured. However, all areas were also affected by the oiliness of the skin. Soft tissue thickness (SMAS and muscle) underlying the dermis was variable. Patients of non-Caucasian background were more likely to have a thicker soft tissue layer. CONCLUSIONS: The "skin pinch test" is an easy and reliable way for the surgeon to evaluate the thickness of the nasal soft tissue envelope. The rhinoplasty surgeon can make decisions pre- and postoperatively to treat patients with difficult soft tissue envelopes. LEVEL OF EVIDENCE 4.

Thickness of skin and subcutaneous tissue of the free flap donor sites: A histologic study.

PURPOSE: The aim of this study is to compare the thickness of skin and hypodermis of the free flap donor sites. METHODS: In 12 cadavers, specimens were harvested from donor sites of radial forearm flap (RF), anterolateral thigh flap (ALT), thoracodorsal perforator flap (TD), and deep inferior epigastric perforator flap (DIEP). Tissues were stained with Masson-trichrome. RESULTS: The thickness of the epidermis ranged 32-42 µm according to the donor sites. The thickness of the dermis ranged 949-1,350 µm. The dermis of the TD (2,152 ± 575 µm) was the thickest. The thickness of the hypodermis ranged 1,913-7,105 µm. The hypodermis of the DIEP (7,105 ± 4,543 µm) was the thickest followed by the ALT (6,012 ± 4,092 µm) and TD (4,688 ± 1,905 µm). The dermis (949 ± 311 µm) and the hypodermis (1,913 ± 1,066 µm) of the RF were the thinnest. As the thickness of the dermis increased, the thickness of the hypodermis also increased. CONCLUSION: Thin hypodermis was found in radial forearm flap and thoracodorsal perforator flap donor sites, which may be used for reconstruction of thin defects.

Shape and Height of Tarsal Plates.

The aim of this study is to elucidate the anatomic detail of the shape and height of the tarsal plates in Koreans.Fifty-four eyelids from Korean adult cadavers were used. Skin, subcutaneous tissue, and the orbicularis oculi muscle were all removed and the tarsal plates were exposed. The shapes of the tarsal plates were observed and the vertical heights of the tarsal plates were measured at its 1/4 (medial), 2/4 (central), and 3/4 (lateral) horizontal length.Tarsal plates were semilunar shaped and classified into 3 types: symmetric, medially skewed, and laterally skewed. For the upper eyelids, the laterally skewed type was the most frequent (42, 77.8%), followed by the medially skewed (8, 14.9%), and symmetric (4, 7.4%). For the lower eyelids, the laterally skewed type (20, 36.7%), the medially skewed (18, 33.3%), and symmetric type (16, 30.0%) had similar ratios. The vertical height of the upper tarsal plate was greatest at the central point (9.3 ±â€Š0.9 mm), followed by the lateral point (7.1 ±â€Š1.0 mm), and the medial point (6.2 ±â€Š0.8 mm). The height of the lower tarsal plate was also greatest at the central point (4.6 ±â€Š0.6 mm), followed by the medial point (3.9 ±â€Š0.5 mm), and the lateral point (3.8 ±â€Š0.5 mm). The base-height ratio of the upper tarsal plate was approximately 7:3 (2.344).Caucasians have wider (25-30 mm) and higher (10-12 mm) upper tarsal plates than those of Asians (21.8 mm, 9.3 mm). The vertical height of the lower tarsal plate, however, is similar both in Caucasians (4-5 mm) and in Asians (4.6 mm). Our results would be helpful for supratarsal fixation in Asian blepharoplasties.

SMAS Fusion Zones Determine the Subfascial and Subcutaneous Anatomy of the Human Face: Fascial Spaces, Fat Compartments, and Models of Facial Aging.

BACKGROUND: Fusion zones between superficial fascia and deep fascia have been recognized by surgical anatomists since 1938. Anatomical dissection performed by the author suggested that additional superficial fascia fusion zones exist. OBJECTIVES: A study was performed to evaluate and define fusion zones between the superficial and the deep fascia. METHODS: Dissection of fresh and minimally preserved cadavers was performed using the accepted technique for defining anatomic spaces: dye injection combined with cross-sectional anatomical dissection. RESULTS: This study identified bilaminar membranes traveling from deep to superficial fascia at consistent locations in all specimens. These membranes exist as fusion zones between superficial and deep fascia, and are referred to as SMAS fusion zones. CONCLUSIONS: Nerves, blood vessels and lymphatics transition between the deep and superficial fascia of the face by traveling along and within these membranes, a construct that provides stability and minimizes shear. Bilaminar subfascial membranes continue into the subcutaneous tissues as unilaminar septa on their way to skin. This three-dimensional lattice of interlocking horizontal, vertical, and oblique membranes defines the anatomic boundaries of the fascial spaces as well as the deep and superficial fat compartments of the face. This information facilitates accurate volume augmentation; helps to avoid facial nerve injury; and provides the conceptual basis for understanding jowls as a manifestation of enlargement of the buccal space that occurs with age.

Preliminary data on dermis and subcutis thickness in adults with type 1 and 2 diabetes mellitus.

We compared the thickness of both dermis and subcutis (measured using ultrasound) in overweight and obese adults with type 1 (n = 10) or type 2 (n = 8) diabetes mellitus. When adjusted for confounding factors, patients with type 1 diabetes had thicker subcutis than those with type 2 diabetes, with this difference being particularly marked in the abdomen. There were no observed differences in dermal thickness between the groups.

Three-dimensional study of the skin/subcutaneous complex using in vivo whole body 3T MRI: review of the literature and confirmation of a generic pattern of organization.

PURPOSE: With a view to developing a tool for predicting the behavior of soft tissues during plastic surgery procedures, we looked for the existence of homologies in the overall pattern of organization of the skin/subcutaneous tissue complex between various body parts, using high-resolution in vivo imaging methods and data available in the literature. METHODS: 3T MRI scanning sequences were performed using appropriate radiofrequency coils on the face, thorax, breast, abdomen and lower extremity of six healthy volunteers. The radiological findings were segmented and converted into volumetric data. RESULTS: The superficial and deep adipose tissue was found to be clearly separated by an intermediate layer called stratum membranosum or superficial fascia. This continuous layer covered all the anatomical parts of the body examined. It was found to have several components in the trunk and limbs and to form a continuous layer with the superficial muscular aponeurotic system in the face. A retaining connective network consisting of superficial and deep retinacula cutis detected in all the regions investigated sometimes formed more densely packed structures playing the role of skin ligaments. CONCLUSION: The results of a 3T MRI study on subcutaneous tissue showed the existence of a common pattern of organization of the skin-subcutaneous tissue complex in the various parts of the body studied. This general model is subject to quantitative variations and tissue differentiation processes promoting the sliding or contractility of the supporting tissue. Three-dimensional reconstructions were obtained by post-processing the MRI images and will be used to perform pre-surgical simulations by settings a generic model that can be adapted to the different localization of the human body in a procedural way.

Differences in degradation behavior of two non-cross-linked collagen barrier membranes: an in vitro and in vivo study.

OBJECTIVES: Collagen barrier membranes are used in guided bone regeneration/guided tissue regeneration because of their excellent bio- and cytocompatibility. However, they are considered to have limitations in clinical outcome because of rapid and unpredictable degradation profiles. The aim of this study was to investigate the degradation behavior of two porcine-based, non-cross-linked collagen membranes in vitro and in vivo. MATERIALS AND METHODS: Remaix™ (RX; Matricel GmbH, Herzogenrath, Germany) and Bio-Gide® (BG; Geistlich Pharma AG, Wolhusen, Switzerland) membranes were characterized by testing mechanical strength, denaturation temperature, enzymatic degradation and hydroxyproline content in vitro (n = 5 up to 16). Thereafter, both membranes were implanted subcutaneously in rats (n = 20) for up to 20 weeks to investigate tissue compatibility with respect to membrane thickness. RESULTS: BG contained a significant higher hydroxyproline content compared with RX, but RX showed a higher stress at break (dry: 11.4 (SD 2.9) vs. 5.5 (SD 1.5) N/mm(2)), higher suture retention (wet: 5.6 (SD 1.3) vs. 2.7 (SD 0.7) N), increased denaturation temperature (55.1 (SD 1) vs. 49.4 (SD 0.6)°C) and an almost twofold reduction in degradation rate (15.6% (SEM 1.3)/h vs. 24.8% (SEM 2.9)/h) in vitro. In the rat model, both membranes showed excellent tissue compatibility without signs of inflammatory reactions. Shortly after implantation, RX and BG showed moderate infiltration of mononuclear cells that appeared not to be influenced by the surface texture of the membranes. In the histomorphometric analysis, both membranes showed significant different thickness over the 20 weeks period (P = 0.0002). Although the thickness remained almost stable during the first 9 weeks after implantation, after 20 weeks, the thickness of RX decreased only slightly, whereas BG showed a thickness loss of around 50% and stronger degradation than RX. Therefore, the higher stability of RX against biodegradation found in vitro was confirmed in the animal study. CONCLUSION: This study shows differences in the biodegradation characteristics of two non-cross-linked collagen membranes in vitro and in vivo. Whether the higher stability of RX is of clinical relevance should be analyzed in future clinical investigations.

Clinical experience of J-VAC drain for skin closure in the laparotomy of obstetrics and gynecology.

AIM: The frequency of wound dehiscence after abdominal surgery has been reported to be approximately 4-29%, and that of surgical site infections is said to be of about 20%. We examined the effectiveness of the subcutaneous J-VAC drain (JVD) in the drainage of bleeding and exudates from surgical wounds. MATERIAL AND METHODS: The study was conducted on 192 patients who underwent abdominal surgery from October 2009 to February 2011, and in whom indwelling JVD were placed. During the study period, JVD (10-Fr) were placed subcutaneously on the anterior surface of the fascia in all patients. We examined the frequency of surgical wound complications. RESULTS: A longitudinal incision was used in 101 patients, and a transverse abdominal incision was used in 91 patients. Subjects with a subcutaneous fat thickness of 2 cm or thicker accounted for 115 patients. Subcutaneous hematoma was present in three patients, but only two patients (1%) showed dehiscence that required treatment. CONCLUSIONS: This study revealed that subcutaneous JVD is useful for the closure of surgical incisions in gynecology and obstetrics, and that there are no limitations to their applicability.

[Preliminary study on internal information of the measured tissue based on distributed multi-position scattering spectroscopy].

The present paper describes the design of pellicle-milk double-layer phantom experiment. Milk solution of 40 different concentrations represents internal information of tissue, 1 to 5 pellicle which covers above the milk solution represents interference information of superficial tissue. The experiment collected 200 scattering spectral data of two positions and took the one single position spectral group as control, and then respectively predicted the milk solution concentration on bottom layer with the ratio of 3:1 through the BP neural network method. The experimental results show that single position scattering spectrum and two-position scattering spectrum both reached more than 90% training fitting rates and prediction accuracy, and the prediction accuracy of two-position scattering spectra is higher, reaching 98.41%. It was verified by the experimental results that scattering spectrum based on photon dissemination path can efficiently predict the milk solution concentration and eliminate the influence of superficial tissue for measurement of internal organization, and considering multi-position in modeling process can improve the accuracy of the prediction. This study validates the feasibility of the method for exploring internal information of tissue without damaging tissue integrity.

Depth of the subcutaneous tissue in the nose: Application to filler injection.

INTRODUCTION: The nasal region plays a pivotal role in both facial esthetics and functionality. The use of volumizing fillers has emerged as a potential means to enhance nasal appearance. Preliminary findings from cadaveric studies have highlighted potential risks associated with deeper needle injection, leading to cartilage damage and lateral migration of filler material. Understanding the subcutaneous tissue depth is crucial to prevent such complications and ensure safe filler placement guided by anatomical knowledge. METHODS: This study aimed to employ ultrasonographic assessment to precisely measure the depth of soft tissue in the nasal area. Fifty-two participants without prior nasal surgery or filler injections underwent detailed ultrasonographic evaluation, focusing on seven key anatomical points: Glabellar, Sellion, Rhinion, between Rhinion and Pronasal, Pronasal, between Pronasal and Subnasal, and Subnasal. RESULTS: The ultrasonographic observation revealed varying depths of subcutaneous tissue across these points: Glabellar (4.11 ± 0.79), Sellion (5.21 ± 0.97), Rhinion (2.02 ± 0.74), Rhinion to Pronasal midpoint (6.45 ± 3.1), Pronasal (9.5 ± 2.2), between Pronasal and Subnasal (8.8 ± 0.8), and Subnasal (8.5 ± 0.5). DISCUSSION: The discussion underscores the significance of understanding subcutaneous tissue depth in guiding needle length and approach angles during filler injections. This knowledge aids in achieving effective filling while ensuring safe placement within the subcutaneous tissue.