The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes.

We reviewed the article titled "The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes" authored by Mortada et al. in Aesthetic Plastic Surgery with considerable interest. This study presents a meticulous systematic review of research examining clinical and patient-reported results in hyaluronic acid (HA) non-surgical rhinoplasty. However, we hold specific reservations about the methodologies employed in the studies encompassed within their analysis. Precise comprehension of the properties of the utilized active substance is essential for any treatment, with standardization being a key factor. Understanding the essential characteristics of the administered HAs is pivotal to establish potential connections between these attributes, outcomes, and complications. Of particular importance in the clinical application of tissue volumization via fillers is rheology, the study of material flow and deformation under stress. Gaining insight into HA's rheological properties is imperative when selecting an appropriate dermal filler for nasal applications. Three pivotal HA properties are viscosity, elasticity, and cohesiveness. While appreciating the authors' contributions, further analysis should account for these factors in their investigation.Level of Evidence V 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 .

A Two-Center, Prospective, Randomized Controlled Trial to Evaluate the Efficacy and Safety of and Satisfaction with Different Methods of ART FILLER® UNIVERSAL Injection for Correcting Moderate to Severe Nasolabial Folds in Chinese Individuals.

The article titled "A Two-Center, Prospective, Randomized Controlled Trial to Evaluate the Efficacy and Safety of and Satisfaction with Different Methods of ART FILLER® UNIVERSAL Injection for Correcting Moderate to Severe Nasolabial Folds in Chinese Individuals," authored by Feng et al. in Aesthetic Plastic Surgery, aims to compare two hyaluronic acid (HA) injection techniques for enhancing nasolabial folds: the conventional injection method and the ligament injection method. However, concerns have arisen regarding the methodology employed in this study. Having a precise understanding of the properties of the active substance is crucial for treatment standardization. It is imperative to comprehensively grasp the key characteristics of the employed HAs to determine any potential correlation between these properties, outcomes, and the likelihood of complications. Understanding HA's rheological properties, including viscosity, elasticity, and cohesiveness, is essential for selecting the most appropriate facial filler. While recognizing the authors' contributions, we firmly believe that further analysis should encompass these factors.Level of Evidence V 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 .

Nonsurgical Chin Augmentation Using Hyaluronic Acid: A Systematic Review of Technique, Satisfaction, and Complications.

The article titled "Nonsurgical Chin Augmentation Using Hyaluronic Acid: A Systematic Review of Technique, Satisfaction, and Complications" by Ou et al. in Aesthetic Plastic Surgery presents a systematic review focused on categorizing complications associated with hyaluronic acid (HA) dermal fillers. However, concerns arise regarding the methodologies employed in the reviewed studies. It is essential to have precise knowledge of the properties of the active substance for treatment standardization. Gaining a comprehensive understanding of the key characteristics of the HA used is paramount to determine if there is an association between these properties and the risk of complications.Understanding HA's rheological properties, including viscosity, elasticity, and cohesiveness, is crucial for selecting the most suitable facial filler. While we acknowledge the authors' contributions, we strongly believe that further analysis should incorporate these factors.Level of Evidence V 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 .

Rhinofiller: Fat Grafting (Surgical) Versus Hyaluronic Acid (Non-surgical).

We conducted a thorough examination of the paper titled " Rhinofiller: Fat Grafting (Surgical) Versus Hyaluronic Acid (Non-surgical)" authored by Gentile et al. in Aesthetic Plastic Surgery with significant interest. The author shared their practical insights gained from employing "fat grafting" and "hyaluronic acid" methods for nasal remodeling in a randomized controlled trial. The research is notably captivating and executed with commendable proficiency. However, we do hold specific reservations concerning the methodologies employed. Precise understanding of the properties of the active substances utilized is fundamental for any medical intervention, and standardization stands as a pivotal element. It is essential to grasp the core characteristics of the administered HAs to potentially uncover links between these attributes, resulting outcomes, and possible complications. In the context of tissue volumization using fillers, rheology-an investigation into material flow and deformation under stress-holds particular importance. Gaining a comprehensive understanding of HA's rheological properties is imperative, especially when selecting an appropriate dermal filler for nasal applications. Among the critical properties of HA are viscosity, elasticity, and cohesiveness. While acknowledging the valuable contributions made by the authors, it is imperative that further analysis takes into account these influential factors during the course of their investigation. LEVEL OF EVIDENCE V: 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 .

Adverse Events Associated with Hyaluronic Acid Filler Injection for Non-Surgical Facial Aesthetics: A Systematic Review of High Level of Evidence Studies.

The article titled "Adverse Events Associated with Hyaluronic Acid Filler Injection for Non-surgical Facial Aesthetics: A Systematic Review of High Level of Evidence Studies" by Kyriazidis et al.in Aesthetic Plastic Surgery presents a systematic review focused on categorizing complications linked to hyaluronic acid (HA) dermal fillers. However, concerns arise about the methodologies employed in the reviewed studies. Precise knowledge of the active substance's properties is vital for treatment standardization. Gaining a comprehensive understanding of the key characteristics of the employed HA is of paramount importance to ascertain whether an association exists between these properties and the risk of complications. Understanding the rheological properties of HA, including viscosity, elasticity, and cohesiveness, is crucial for optimal facial filler selection. Acknowledging the authors' contributions, further analysis should encompass these factors.Level of Evidence V 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 .

Laser Speckle Contrast Imaging Guides Needling Treatment of Vascular Complications from Dermal Fillers.

We have read the article titled "Laser Speckle Contrast Imaging Guides Needling Treatment of Vascular Complications from Dermal Fillers" by Tsai et al. in Aesthetic Plastic Surgery, and we are deeply interested in their research. The study explores the use of laser speckle contrast imaging (LSCI) for evaluating and treating vascular complications in six patients who experienced issues after facial dermal filler injections. The authors found that LSCI accurately and noninvasively identified vascular occlusions in real time, surpassing the accuracy of visual and photographic assessments. This suggests that LSCI can be a valuable tool for clinicians to monitor therapeutic outcomes following interventions for vascular occlusions. While we appreciate the study's significance and quality, we have specific concerns regarding the methodologies employed to prevent complications related to hyaluronic acid (HA). Understanding the properties of the active substance is crucial for standardization in medical treatments. A comprehensive understanding of HA's essential characteristics is vital to determine if correlations exist between these properties, treatment outcomes, and the risk of complications. Key considerations include rheology, which studies how matter flows and deforms under strain, viscosity, elasticity, cohesiveness, and gel texture. These factors play a vital role in the safety and efficacy of dermal filler treatments.Level of Evidence V 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 .

Effectiveness and Role of Using Hyaluronic Acid Injections for Gluteal Augmentation: A Comprehensive Systematic Review of Techniques and Outcomes.

We have reviewed the article "Effectiveness and Role of Using Hyaluronic Acid Injections for Gluteal Augmentation: A Comprehensive Systematic Review of Techniques and Outcomes" by Mortada et al. in Aesthetic Plastic Surgery with keen interest. This study aims to comprehensively assess the effectiveness and role of hyaluronic acid (HA) in gluteal augmentation. However, we raise concerns about the methodologies employed in the reviewed studies. For effective treatments, understanding the properties of the active substance is essential for standardization. Thoroughly grasping the key characteristics of the employed HAs is vital to identify correlations between these properties, outcomes, and complication risks. Understanding HA's rheological properties, including viscosity, elasticity, and cohesiveness, is pivotal for selecting appropriate dermal fillers for the gluteal region. Another significant aspect of HA use is cohesiveness, arising from internal adhesion based on HA concentration and cross-linking. This cohesiveness resists vertical forces upon implantation, influencing tissue lifting and projection. Gel texture, influenced by Cross-Linking Degree, Particle Size, Molecular Weight, and HA Concentration, also plays a crucial role. While acknowledging authors' contributions, further analysis should consider these factors. LEVEL OF EVIDENCE V: 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 .

Myomodulation with Facial Fillers: A Comprehensive Technical Guide and Retrospective Case Series.

The article titled "Myomodulation with Facial Fillers: A Comprehensive Technical Guide and Retrospective Case Series" by Coimbra et al. in Aesthetic Plastic Surgery presents a technical guide for holistic facial treatment using hyaluronic acid (HA) fillers and a map for addressing individual facial units through myomodulation. The authors' approach is appreciated for its value. However, concerns arise about the employed methodologies. Understanding HA's properties is vital for treatment standardization. The significance of HA's rheological properties, encompassing viscosity, elasticity, and cohesiveness, is critical for optimal dermal filler selection. The authors' insights are acknowledged, yet further analysis considering these factors is recommended. LEVEL OF EVIDENCE V: 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 .

Extensive severe intraorbital arteriovenous malformations: report of a rare laser complication and successful management.

Arteriovenous malformations (AVMs) are rare congenital errors of vascular morphogenesis, characterised by abnormal direct communications between arteries and veins, bypassing the normal capillary bed. Apart from the central nervous system, typical locations include the head and neck, and less frequently limbs, trunk or internal organs. AVMs of the head and neck often become clinically evident and symptomatic only in later childhood and are characterised by a history of variable growth, sometimes leading to large, deforming, pulsating masses with a propensity to massive haemorrhage. Therapeutic strategy is based on selective embolisation, surgical excision, or a combination of both. Radical surgical excision of local AVMs is the only effective treatment but it may be mutilating, especially for AVMs of the head and neck. Laser therapy represents a good option to treat the cutaneous aspects of AVMs nevertheless, its efficacy is limited. To the date, pharmacological therapy for AVMs is still on debate due to its controversial outcomes as it seems not as effective as other treatments and usually requires a longer course of application. However, pharmacological therapy could be useful in selected patients and for AVMs nonresponsive to traditional treatment, allowing them to obtain acceptable results without serious complications. This paper reports the case of a serious laser complication of extensive intraorbital AVM successfully treated by local reconstruction and topical pharmacological treatment.

Enzymatic Debridement in Severe Burn COVID-19 Patients: A Case Series.

The presence of a high number of positive SARS-CoV-2 patients is found daily in the emergency room database, finding evidence of infection also in trauma and burns. Surgical debridement remains the gold standard for eschar removal, but it does not come without complications such as bleeding and high heat loss. In recent years, there has been an increase in the use of enzymatic debridement techniques, replacing surgical escharotomy. Early eschar removal is proven to be important; it has been proved that an early and effective burn treatment in COVID-19 patients can reduce other infection. Five clinical cases of patients arrived at our COVID-19 Major Burns Intensive Care Unit. On admission, burns extension and depth were assessed by an expert burn surgeon. We evaluated eschar removal modality, adverse events, and potential side effects. Enzymatic debridement was efficient in all patients treated with complete eschar removal, and no serious adverse events. All patients were treated within 24 hours of arrival at our facility with Nexobrid by specialized personnel in deep sedation and with O2 support using a face mask or nasal goggles. The use of enzymatic debridement in COVID-19-positive burn patients within dedicated pathways through nonsurgical treatment optimizes the treatment time. We believe that the use of enzymatic debridement could be a valid therapeutic option in burn patients, even with SARS-CoV-2 infection, and its use, when indicated, is safe and effective for the patient and optimizes the use of instrumental and human resources in a pandemic emergency.

Italian recommendations on enzymatic debridement in burn surgery.

INTRODUCTION: Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)'s role based on the practice knowledge of expert Italian users. METHODS: The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. RESULTS: The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. DISCUSSION: The statements provided by the Italian consensus panel represent a "ready to use" set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available.

Releasing Burn-Induced Compartment Syndrome by Enzymatic Escharotomy-Debridement: A Case Study.

Burn-induced compartment syndrome represents a serious and acute condition in deep circumferential burns of the extremities which, if left untreated, can cause severe complications. The surgical escharotomy that releases the high subdermal pressure is the therapeutic treatment of choice for burn-induced compartment syndrome. Guidelines for escharotomy indications and timing include pressure greater than 30 mm Hg and 6 Ps (Pain, Pallor, Paresthesia, Paralysis, Pulseless, and Poikilothermia). Nevertheless, despite the need for an early as possible pressure release, escharotomy is often delayed when a capable surgeon is not available, or if the indication is not completely clear to justify potential risks associated with surgical escharotomy. Early treatment of circumferential burns of the extremities with a Bromelain-based enzymatic agent NexoBrid® may represent a less traumatic and invasive procedure to reduce intra-compartmental pressure, replacing surgical escharotomy. This case study of 23 patients describes the variation of compartmental pressure in patients with circumferential burns of the extremities treated with NexoBrid® enzymatic escharotomy-debridement. All the patients were treated with NexoBrid® within 2 to 22 hours post-injury in our Burn Intensive Care Center. The excessive pressure recorded before treatment returned to normal below 30 mm Hg and an approximately 60% reduction of the compartmental pressure was observed in most cases within 1 hour from NXB application. On NexoBrid® removal after 4 hours complete debridement-escharotomy of the burns was achieved. Enzymatic escharotomy-debridement appears to be a useful and safe method to reduce postburn compartmental pressure. Additional randomized, well-controlled powered studies are needed to further support these results.

Chitosan Gel to Treat Pressure Ulcers: A Clinical Pilot Study.

Chitosan is biopolymer with promising properties in wound healing. Chronic wounds represent a significant burden to both the patient and the medical system. Among chronic wounds, pressure ulcers are one of the most common types of complex wound. The efficacy and the tolerability of chitosan gel formulation, prepared into the hospital pharmacy, in the treatment of pressure ulcers of moderate severity were evaluated. The endpoint of this phase II study was the reduction of the area of the lesion by at least 20% after four weeks of treatment. Thus, 20 adult volunteers with pressure ulcers within predetermined parameters were involved in a 30 days study. Dressing change was performed twice a week at outpatient clinic upon chronic wounds management. In the 90% of patients involved in the study, the treatment was effective, with a reduction of the area of the lesion and wound healing progress. The study demonstrated the efficacy of the gel formulation for treatment of pressure ulcers, also providing a strong reduction of patient management costs.

Giant breast tumors in a patient with Beckwith-Wiedemann syndrome.

Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder with increased risk of embryonal tumors, such as Wilms tumor, hepatoblastoma, neuroblastoma, and rhabdomyosarcoma. We report on a patient with BWS that developed a giant fibroadenoma of the breast that was surgically removed. The tumor relapsed 8 months after the surgery and the patient underwent partial mastectomy. Although the patient presented several clinical features of BWS, a molecular diagnosis was not achieved despite extensive molecular investigations on both blood and tumor tissue. A SNP array revealed a de novo 7p22.1 loss in both blood and breast tumor involving the mismatch repair gene PMS2 gene that may be potentially associated with the breast tumor. In conclusion, it remains unclear whether BWS patients have an increased risk of breast lesions or a yet unknown molecular defect is responsible for the rare occurrence of this tumor in BWS.