Classification of Alar Dynamic Aesthetic in an Asian Female Population: Experts or Automatic Algorithms?

AIM: To provide referenced classifications of alar dynamic aesthetics from both subjective and objective perspectives for determining proper surgical strategies in alarplasty. METHODS: A total of 150 healthy Asian female participants were instructed to perform two standardized facial movements including a resting pose and a maximum smile while taking care not to show their teeth. The participants were recorded using a dynamic three-dimensional surface imaging system. Frames depicting the resting position and the alar maximum enlargement during the smile were exported separately for anthropometric analysis and classification. The alar dynamic aesthetic was assessed through measurement of the anthropomorphic changes comparing the resting and maximum smile statuses and then transformed into quantitative analysis through the algorithm [Formula: see text]. Subjective classification and evaluation of the subject cosmetic deficiencies and proposals for therapeutic interventions to improve the subjects' alar dynamic aesthetic were performed by three senior plastic surgeons through visualization of the resting and smiling images. The surgeons were asked to divide and classify the subjects into three groups (Class I, Class II and Class III) according to the surgeons' perceptions of degree of the subjects' deficiencies in alar dynamic aesthetic. The more deficiency there was in the aesthetic, the higher the class that the subject was assigned into. The surgeons were presented with the full set of images of the patients on two separate occasions each three months apart, to assess interobserver reliability. Clustering analysis, which is based on machine learning, was applied for objective classification of the images. RESULTS: According to the senior plastic surgeon experts' subjective classification, the subjects' alar flaring mobility was judged as follows: Class I (6.78 ± 3.84%), Class II (10.35 ± 4.18%), and Class III (18.68 ± 4.15%), while alar base mobility was judged as Class I (12.71 ± 7.57%), Class II (20.06 ± 10.06%), and Class III (30.86 ± 13.20%). By clustering analysis, alar flaring mobility was determined to be Class I (7.01 ± 3.51%), Class II (11.18 ± 4.76%), and Class III (12.72 ± 5.66%), while alar base mobility was Class I (9.07 ± 4.23%), Class II (21.88 ± 4.25%), and Class III (38.59 ± 7.08%). No statistical significance was found in the distribution and assignment of classes between the two methodologies. CONCLUSION: Classifications of alar dynamic aesthetics could arouse attention to facial dynamic aesthetics and provide referenced quantitative parameters for plastic surgeons to determine appropriate treatments for alarplasty. For patients with Class I mobility, treatments are not recommended, while minimally invasive treatments can be deemed to be optional for patients with Class II alar mobility to potentially improve alar dynamic aesthetics. For patients with Class III alar mobility, surgical treatments are strongly recommended as options. Combing subjective classification with automated algorithms can provide a novel perspective and improve reliability for facial aesthetic classification analysis. 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 .

Effect of a subset of adipose-derived stem cells isolated with liposome magnetic beads to promote cartilage repair.

This study aimed to investigate the ability of CD146+ subset of ADSCs to repair cartilage defects. In this study, we prepared CD146+ liposome magnetic beads (CD146+ LMB) to isolate CD146+ ADSCs. The cells were induced for chondrogenic differentiation and verified by cartilage-specific mRNA and protein expression. Then a mouse model of cartilage defect was constructed and treated by filling the induced cartilage cells into the damaged joint, to evaluate the function of such cells in the cartilage microenvironment. Our results demonstrated that the CD146+ LMBs we prepared were uniform, small and highly stable, and cell experiments showed that the CD146+ LMB has low cytotoxicity to the ADSCs. ADSCs isolated with CD146+ LMB were all CD146+ , CD105+ , CD166+ and CD73+ . After chondrogenic induction, the cells showed significantly increased expression of cartilage markers Sox9, collagen Ⅱ and aggrecan at protein level and significantly increased Sox9, collagen Ⅱ and aggrecan at mRNA level, and the protein expression and mRNA expression of CD146+ ADSCs group were higher than those of ADSCs group. The CD146+ ADSCs group showed superior tissue repair ability than the ADSCs group and blank control group in the animal experiment, as judged by gross observation, histological observation and histological scoring. The above results proved that CD146+ LMB can successfully isolate the CD146+ ADSCs, and after chondrogenic induction, these cells successfully promoted repair of articular cartilage defects, which may be a new direction of tissue engineering.

Combined Transverse Incision and Pouch Incision for the Correction of Medial Epicanthus.

BACKGROUND: The epicanthal fold is a distinct characteristic of the upper eyelid in many Asians. To achieve satisfactory results, epicanthoplasty is usually performed with double eyelid plasty and blepharoptosis. Although many surgical procedures have been reported for the elimination of epicanthal folds, such as recurrence, copious designs, conspicuous scar, and unnatural palpebral contours are challenges to the surgeon and also make patients worried. METHODS: From June 2010 to June 2015, epicanthoplasty was performed for 236 Chinese female patients using transverse incision combined with pouch incision. The transverse straight incision was performed in new inner canthus to the original eanthal corner point, after the original inner canthus corner point was reached, the oblique parallel incision was performed along the lower eyelid, so that full subcutaneous separation was obtained on the upper and lower incision, the malpositioned isomerous orbicular muscle and thickened tissue were released and excised, so that the epicanthus skin was naturally restored, and finally the incision was sutured without tension. The extent of postoperative scarring and improvement of the epicanthal fold were evaluated after surgery. The medial canthal distance was measured preoperatively and 12 months postoperatively. RESULTS: The average intercanthal distance decreased significantly from a mean of 41.68 ±â€Š2.57 mm preoperatively to 37.14 ±â€Š1.94 mm 12 months postoperatively (P < 0.05, paired t-test). And all patients were satisfied with the excellent aesthetic results in terms of an open medial canthus without definite recurrence, hypertrophic scarring, and other complications during the 12-month follow-up period. CONCLUSION: Epicanthoplasty with transverse incision and pouch incision is a simple and effective method for elimination epicanthal folds, resulting in a pleasant visualization, inconspicuous scar. However, its long-term effects require further study.