Introduction and validation of an automatic and low-cost three-dimensional facial imaging system: a comparison to direct anthropometry and Vectra H1.

Background: Three-dimensional (3D) imaging is a powerful tool for the analysis of soft tissue morphology. 3D photogrammetry outperforms conventional photogrammetric methods and gains popularity among plastic surgeons. However, commercial 3D imaging systems bundled with analytical software are costly. This study intends to introduce and validate an automatic, low-cost, and user-friendly 3D facial scanner. Methods: An automatic and low-cost 3D facial scanning system was developed. The system consisted of a 3D facial scanner running automatically on a sliding track and a 3D data processing tool. Fifteen human subjects underwent 3D facial imaging by the novel scanner. Eighteen anthropometric parameters were measured on the 3D virtual models and compared with caliper measurements (the gold standard). Further, the novel 3D scanner was compared to the commonly used commercial 3D facial scanner Vectra H1. Heat map analysis was used to evaluate the deviation between the 3D models obtained by the two imaging systems. Results: The 3D photogrammetric results were highly correlated with the direct measurement results (P<0.001). The mean absolute differences (MADs) were less than 2 mm. Bland-Altman analysis indicated that, for 17 of the 18 parameters, the largest differences within the 95% limits of agreement margin were within the 2.0 mm clinical acceptance. Heat map analysis showed the average distance between the 3D virtual models was 0.15 mm, with a root mean square of 0.71 mm. Conclusions: The novel 3D facial scanning system is proven to be highly reliable. It provides a good alternative to commercial 3D facial scanners.

Does Double-Eyelid Blepharoplasty Improve Forehead Wrinkles? A Prospective Study Using FACE-Q Scale and Anthropometric Measurements.

BACKGROUND: Single eyelids are common among Asians. It is not uncommon to see people with single eyelids raise their eyebrows to wide open their eyes. This results in frequent compensatory contraction of the frontalis muscle and thus leads to deep forehead wrinkles. Double-eyelid blepharoplasty creates a larger visual field. In theory, patients who receive the surgery will stop overusing the frontalis muscle. Therefore, the forehead wrinkles can be improved. METHODS: 35 patients who underwent double-eyelid blepharoplasty were enrolled. FACE-Q forehead wrinkle assessment scale was adopted to evaluate the forehead wrinkles preoperatively and postoperatively. In addition, anthropometric measurements were taken to indirectly evaluate frontalis muscle contraction in maximum eye-opening position. RESULTS: According to the FACE-Q scale, forehead wrinkles were improved after double-eyelid blepharoplasty, and the improvement was long-lasting in the 3-month follow-up. This was because the frontalis muscle contraction reduced after the surgery, as shown by the anthropometric measurements. CONCLUSION: This study used subjective and objective methods to prove that double-eyelid surgery improves forehead wrinkles. 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 .

Studying Dynamics of Mid-face Lifting During Hyaluronic Acid Filler Injection Using Ultrasound Imaging.

BACKGROUND: The ageing in the mid-face involves volume deficiency in multiple anatomical units, including the zygomatic arch, infraorbital region, medial and lateral cheek and nasolabial fold (NLF). Hyaluronic acid (HA) is extensively used in the minimally invasive procedures of mid-face rejuvenation. OBJECTIVES: MD CodesTM is proposed to perform combined treatment of multiple sites to reduce treatment variability and increase clinician success rates. Although the detailed procedure of this technique, aesthetic effects and complications have been disclosed, its anatomical information has yet to be discussed. This paper elaborated on the static and dynamic anatomical characteristics of MD CodesTM through cadaveric dissection and ultrasound imaging. METHODS: Anatomical dissection and ultrasound imaging help us look back on the injection methods and anatomical principles of MD CodesTM. RESULTS: The treatment is threefold: (1) the bolus injections, for lifting purposes, are performed at the most depressing point along the zygomatic arch, zygomatic eminence, the prominent optimal point in the zygomatic region, the most depressed point of upper NLF with 0.2-0.3 ml HA. (2) The linear injections, featuring facial contouring refinement, are performed at the deep fat pad of the medial cheek and infraorbital region with 0.4 ml HA. (3) The linear injections, featuring volume replacement, are performed at the subcutaneous fat layer of lateral cheek and NLF with 0.8 and 0.4 ml HA. CONCLUSIONS: MD CodeTM is led by the principle of "less dosage and better effect", and a special injection sequence is formulated based on the anatomical characteristics. Ultrasound is a useful tool to make for a dynamic anatomical understanding of MD CodeTM and visualize the anatomical information such as layers and thicknesses. 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 .

Nipple ulcers of the nipple retractor technique to correct inverted nipples: A retrospective multivariate analysis.

BACKGROUND: A simple procedure using a nipple retractor to correct inverted nipples has been applied in clinical practice with stable and satisfactory aesthetic outcomes. Nipple ulceration and necrosis are rare and severe, with the causes unclear. OBJECTIVE: This study aimed to investigate the risk factors for the development of nipple ulcers in the nipple retractor technique. METHODS: A retrospective study was conducted on inverted nipple patients between January 2012 and September 2021. Clinical information, including baseline patient demographics, reproductive history, smoking, previous treatment, nipple inversion grades, nipple size, areola size, blood flow perfusion, and ulcer development, was collected. RESULTS: Twenty-five female patients with 44 inverted nipples were enrolled. Nipple ulcers were present in seven patients, four of whom were bilateral. Logistic regression analysis showed nipple inversion grades (Z = 2.105, OR 7.005, 95% CI: 1.144-42.898, p = 0.035) and relative perfusion of nipples (Z = -2.337, OR 0.969, 95% CI: 0.944-0.995, p = 0.019) were significantly associated with ulceration. The structural equation model demonstrated the interaction of related factors: nipple inversion grades increased by 0.411 points for ulcers (p = 0.004), while relative perfusion of nipples decreased by 0.647 points for ulcers (p < 0.001). CONCLUSION: Preoperative nipple inversion severity and post-operative nipple blood supply may be the risk factors for nipple ulcer development in the nipple retractor technique.

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

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.

Laser Speckle Contrast Imaging for the Objective Assessment of Blood Perfusion in Keloids Treated With Dual-Wavelength Laser Therapy.

BACKGROUND: Most of the widely used methods for the assessment of keloid treatment are subjective grading scales based on the opinion of an individual clinician or patient. There is a growing need for objective methods to evaluate keloid treatment. OBJECTIVE: This study aimed to evaluate the value of laser speckle contrast imaging (LSCI) as an objective method for the assessment of dual-wavelength laser therapy for keloids. METHODS: This prospective study included 21 patients with 54 keloids. All patients were treated with a combined 585-nm pulsed dye laser and 1,064 nm neodymium-doped yttrium aluminum garnet dual-wavelength laser at 4 weeks to 6 weeks intervals. Keloids were assessed using the Vancouver Scar Scale (VSS) and LSCI. RESULTS: The total VSS score significantly decreased after 4 sessions of treatment (p < .05). Blood perfusion in keloids as measured by LSCI was significantly reduced after treatment (p < .05). The improvement of chest keloids in terms of the total VSS score and blood perfusion was significantly greater than that of scapular keloids (p < .05). There was a positive correlation between decreased perfusion and reduced total VSS score (R2 = 0.84). CONCLUSION: Blood perfusion in keloids significantly decreased after dual-wavelength laser therapy. Laser speckle contrast imaging is a promising objective method for assessing the improvement of keloids treated with laser therapy.

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.

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.

Overexpression of microRNA-203 Suppresses Proliferation, Invasion, and Migration while Accelerating Apoptosis of CSCC Cell Line SCL-1.

Cutaneous squamous cell carcinoma (CSCC) is a malignant proliferation of cutaneous epithelium that has been observed to have an alarming rise in incidence. Numerous studies have demonstrated microRNAs (miRNAs or miRs) as important biomarkers in the diagnosis, prognosis, and treatment of CSCC. This study aims to investigate the effects of miR-203 on the behaviors of CSCC cells and possible mechanisms associated with protein regulator of cytokinesis-1 (PRC1) and Wnt/ß-catenin signaling pathway. PRC1 was suggested as a target of miR-203 in squamous cell carcinoma cell line 1 (SCL-1) cells by dual-luciferase reporter gene assay. Based on the immunohistochemical staining and qRT-PCR, PRC1 was abundantly expressed while miR-203 was poorly expressed in CSCC tissues. miR-203 mimic or inhibitor was transfected into SCL-1 cells to upregulate or downregulate its expression. Upregulation of miR-203 downregulated PRC1 expression to block the Wnt/ß-catenin signaling pathway. By conducting 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT), scratch test, and Transwell and flow cytometric analyses, miR-203 was witnessed to restrain SCL-1 cell proliferation, migration, and invasion while accelerating their apoptosis. The rescue experiments addressed that inhibition of the Wnt/ß-catenin signaling pathway conferred the anti-tumor effect of miR-203. These results establish a tumor-suppressive role for miR-203 in CSCC cell line SCL-1. Hence, miR-203 has promising potential as a therapeutic target for CSCC.

Combining micro-plasma radio-frequency with hypofractionated electron-beam radiation as a novel treatment of keloids: A case series.

RATIONALE: Micro-plasma radio-frequency (MPR) technology has been demonstrated a safe and effective treatment for kinds of scars, but there is no report about the application of the MPR on keloids. In this investigation, we creatively use MPR technology combining with hypofractionated electron-beam radiation to cure keloids. PATIENT CONCERNS AND DIAGNOSES: From February 2013 to December 2016, 22 Asian patients (16 male, 6 female, age 19-46 years, mean age 28.14 ±â€Š7.31 years) with keloids over half a year were enrolled in this study. INTERVENTIONS AND OUTCOMES: All patients received a single MPR technology treatment by roller tip at 80-100 watt, and then hypofractionated electron-beam radiation of 6 MeV were performed twice, within 24 hours and one week after the operation with 9 Gy per time. Improvement were determined by the Vancouver Scar Scales (VSS) according to digital photographs. The results show that the volume of keloids reduced significantly among most patients. Only 3 patients encountered with mild to moderate hyperpigmentation, and none of malignance and worsening or recurrence of scars was observed. LESSONS: MPR technology combined with post-operative hypofractionated electron-beam radiation therapy is an effective method for patients with multiple keloids distributed widely on the body with minimal complications, especially for patients with widely distributed keloids.

[Clinical analysis of tuberous sclerosis complex complicated with renal angiomyolipoma: a report of 22 cases].

OBJECTIVE: To explore the diagnosis and treatment of tuberous sclerosis complex complicated with renal angiomyolipoma. METHODS: The clinical data of 22 patients with tuberous sclerosis complex complicated with renal angiomyolipoma were analyzed retrospectively. RESULTS: There were 12 males and 10 females with a mean age of 23 (1-46) years. All of them had bilateral multiple renal angiomyolipomas. The mean tumor size was 8.5 (0.7-18.0) cm in diameter. The presence or absence of clinical symptoms showed a significant correlation with tumor size.Eight patients with angiomyolipoma under 4 cm in diameter were continuously monitored at an outpatient clinic. There were 8 patients with lesions of 4-10 cm.Five of them underwent nephron-sparing surgeries and another 3 monitored at an outpatient clinic. There were 6 patients with tumor over 10 cm. Three of them underwent transcatheter arterial embolization and one case took rapamycin after embolization.One patient with concurrent renal cell carcinoma underwent partial nephrectomy. Chronic renal failure occurred in one case dying of pulmonary lymphangiomyomatosis with serious hemoptysis. During a mean follow-up of 25 months, neither severe renal hemorrhage nor symptomatic aggravation was found.In the case of rapamycin, there was 10% reduction in the size of angiomyolipoma. CONCLUSIONS: Most cases of tuberous sclerosis complex are complicated with bilateral multiple renal angiomyolipoma. The small lesions under 4 cm in diameter may be monitored at an outpatient clinic.For those larger (>4 cm) or symptomatic ones, medication, embolization or surgery is necessary.

Experience of retroperitoneal laparoscopic treatment on pheochromocytoma.

OBJECTIVES: To evaluate the safety and efficacy of retroperitoneal laparoscopic resection for pheochromocytoma. METHODS: The clinical data of 131 cases of pheochromocytoma were analyzed retrospectively. There were 69 males and 62 females with an age range of 8 to 77 years, including 120 cases of adrenal pheochromocytoma and 11 extraadrenal pheochromocytomas. Retroperitoneal laparoscopic resection was performed in all cases. We divided our practical experience into three stages: (1) the tentative and exploratory stage, (2) the accumulative stage, and (3) the mature stage. RESULTS: During the tentative and exploratory stage, 10 patients underwent retroperitoneal laparoscopic surgery. The mean diameter of the tumor was 4.2 cm. The mean operation time was 105 minutes, and the median volume of blood loss during surgery was 450 mL. During the accumulative stage, the mean tumor diameter of the 72 cases was 5.6 cm. The mean operation time was 85 minutes and median volume of blood loss was 140 mL. During the mature stage, the mean tumor diameter of the 49 cases (including 11 extra-adrenal pheochromocytoma patients) was 6.7 cm. The mean operation time was 75 minutes and median volume of blood loss was 70 mL. Follow-ups ranging from 1 to 70 months were conducted, with three cases recurring. There were no cases of distant metastases or death. CONCLUSIONS: Retroperitoneal laparoscopic surgery for pheochromocytoma is feasible and safe. This procedure will be increasingly performed as medical personnel continue to develop their skills and accumulate experience.